|
1
|
Navas-Garrido I, Martín-Núñez J, Raya-Benítez J, Granados-Santiago M, Navas-Otero A, López-López L, Valenza MC. Respiratory Muscle Strength Training in Parkinson's Disease-A Systematic Review and Meta-Analysis. Healthcare (Basel) 2025; 13:1214. [PMID: 40428050 PMCID: PMC12111514 DOI: 10.3390/healthcare13101214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2025] [Revised: 05/15/2025] [Accepted: 05/20/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: The aim of this review was to evaluate the effectiveness of respiratory muscle strength training in patients with Parkinson's disease (PD). Methods: A systematic review and meta-analysis of randomised controlled trials (RCTs) was performed on PubMed, Web of Science, and Scopus databases. We included RCTs that evaluated the effectiveness of respiratory muscle training in patients with PD versus no intervention, sham treatment, or a different type of intervention. Quality assessment and risk of bias were assessed using the Downs and Black scale and the ROB2 tool. Results: Finally, 10 studies were included. The methodological quality of the studies was "good" in most of the studies, with results ranging from 21 to 25. In terms of risk of bias, six of them indicated low risk and four of them showed unclear risk of bias. Data were pooled and a meta-analysis of maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), and voluntary peak expiratory flow rate (PEFR) was performed. Meta-analysis indicated a significant overall effect of respiratory muscle strength training on MEP (MD = 17.08; 95% CI = 2.32, 31.84; p = 0.02) and on voluntary PEFR (MD = 1.50; 95% CI = 0.51, 2.48; p = 0.003). However, results in the meta-analysis showed a non-significant overall effect of respiratory muscle strength training on MIP (MD = 1.69; 95% CI = -11.91, 16.29; p = 0.82). Conclusions: The synthesis of evidence presented in this systematic review and meta-analysis underscores the potential of respiratory muscle strength training as an effective means of increasing MEP and PEFR in patients with PD.
Collapse
Affiliation(s)
- Irene Navas-Garrido
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18071 Granada, Spain; (I.N.-G.); (J.M.-N.); (M.C.V.)
| | - Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18071 Granada, Spain; (I.N.-G.); (J.M.-N.); (M.C.V.)
| | - Julia Raya-Benítez
- Nursing Department, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18071 Granada, Spain; (J.R.-B.); (M.G.-S.)
| | - María Granados-Santiago
- Nursing Department, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18071 Granada, Spain; (J.R.-B.); (M.G.-S.)
| | - Alba Navas-Otero
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Arquitecto Francisco Peñalosa, 3, Campanillas, 29071 Málaga, Spain;
| | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18071 Granada, Spain; (I.N.-G.); (J.M.-N.); (M.C.V.)
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18071 Granada, Spain; (I.N.-G.); (J.M.-N.); (M.C.V.)
| |
Collapse
|
|
2
|
Liou HH, Hsieh MHC, Hung DSY, Liu HL, Lee I, Lin YC, Hsiao JR, Huang CC, Ou CY, Chang CC, Lee WT, Tsai ST, Tsai SW. The Additive Effectiveness of Inspiratory Muscle Training on Glottic Closure and Subjective Voice Outcomes of Patients With Benign Lesion After Hyaluronic Acid Laryngoplasty. J Voice 2025; 39:728-735. [PMID: 36513561 DOI: 10.1016/j.jvoice.2022.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES For patients with glottic insufficiency disease, injection laryngoplasty is a rapid and efficient management option that complements voice therapy. Some studies have indicated that respiratory muscle training may also show promise in patients with voice disorders. However, the effect of respiratory muscle training in patients with glottic insufficiency was reported to be limited, and whether it provides additional benefit after standard management requires further evaluation. We aimed to investigate the effectiveness of inspiratory muscle training on glottis closure and patient-reported voice quality in glottic insufficiency patients who had been treated with hyaluronic acid injection. STUDY DESIGN Retrospective observational study. METHODS We included 46 patients with glottic insufficiency who had undergone hyaluronic acid injection. Twenty of them had undergone inspiratory muscle training during three months. We measured patients' changes in glottic status according to the normalized glottal gap area and bowing index, as well as voice quality of life according to the voice handicap index 10 and the voice outcome survey, before and after training. RESULTS Patients who underwent inspiratory muscle training had higher odds of experiencing better improvement in all scores. The range of odds ratios ranged from 2.5 to 6.3 for changes in scores, and from 3.8 to 22.2 for changes in score percentages. Of note, the effect of training on percentage changes in the normalized glottal gap area score was significant (P= 0.0127) after adjustment for the duration of vocal disease, body mass index and BMI, and history of gastroesophageal reflux disease. CONCLUSIONS Inspiratory muscle training can improve the glottal gap after injection laryngoplasty, and may be applied in clinical practice.
Collapse
Affiliation(s)
- Hsin-Hao Liou
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Miyuki Hsing-Chun Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - David Shang-Yu Hung
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Hui-Ling Liu
- Respiratory treatment room,Department of internal medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ishan Lee
- Respiratory treatment room,Department of internal medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Chih Lin
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Cheng-Chih Huang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Chun-Yen Ou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Chan-Chi Chang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Wei-Ting Lee
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Sen-Tien Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Shu-Wei Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan.
| |
Collapse
|
|
3
|
Duan Y, Guo X, Ren B, Liu F, Li Y, Liu F, Xu F, Huang M. An alternating breathing pattern significantly affects the brain functional connectivity and mood states. Front Hum Neurosci 2025; 19:1539222. [PMID: 40309665 PMCID: PMC12040909 DOI: 10.3389/fnhum.2025.1539222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 03/21/2025] [Indexed: 05/02/2025] Open
Abstract
Introduction To explore the impact of different breathing patterns on brain connectivity and emotional states. Methods We recruited 31 participants with an average age of 19 years. They were instructed to perform controlled breathing, including calm, shallow, deep, and alternating deep and shallow breathing patterns. We employed functional near-infrared spectroscopy (fNIRS) to investigate disparities in the effects of multiple breathing patterns on the brain. Meanwhile, we captured the participants' facial expressions and vital signs. Results There were significant variations in the effects of four breathing patterns on functional connectivity between brain regions, facial expressions, and vital signs. The four breathing patterns impacted six brain regions. Among them, alternating deep and shallow breathing had a particularly pronounced effect, and there was robust functional connectivity in different brain regions. Additionally, this breathing pattern elevated autonomic nervous system activity, which contributed to achieving a more tranquil state. Furthermore, alternating deep and shallow breathing had a more positive influence on the changes in oxyhaemoglobin concentration (Δ [HbO2]) of the brain compared with deep breathing. Discussion Alternating shallow and deep breathing could enhance emotional stability, improve autonomic nervous system function, and promote brain functional connectivity. Our findings unveiled distinct effects of diverse breathing patterns on both the brain and mood state, establishing a theoretical foundation for respiratory rehabilitation training for stroke patients.
Collapse
Affiliation(s)
- Yulin Duan
- Department of Physiology, School of Basic Medical Sciences, Chengdu Medical College, Chengdu, China
- Department of Clinic Medicine, School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Xun Guo
- Department of Clinic Medicine, School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Bingnan Ren
- Department of Clinic Medicine, School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Fang Liu
- Department of Clinic Medicine, School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Yuhang Li
- Department of Clinic Medicine, School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Fangfang Liu
- Department of Art, Art College, Southwest Minzu University, Chengdu, China
| | - Fan Xu
- Department of Evidence-based Medicine and Social Medicine, School of Public Health, Chengdu Medical College, Chengdu, China
| | - Min Huang
- Department of Physiology, School of Basic Medical Sciences, Chengdu Medical College, Chengdu, China
| |
Collapse
|
|
4
|
Çelikel BE, Yılmaz C, Demir A, Sezer SY, Ceylan L, Ceylan T, Tan Ç. Effects of inspiratory muscle training on 1RM performance and body composition in professional natural bodybuilders. Front Physiol 2025; 16:1574439. [PMID: 40260203 PMCID: PMC12009892 DOI: 10.3389/fphys.2025.1574439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Accepted: 03/07/2025] [Indexed: 04/23/2025] Open
Abstract
Background The effect of inspiratory muscle training on upper limbs One Rep Maximum (1RM) in professional natural bodybuilders is still unclear. Our aim of this study is to investigate the effects of a 6 weeks inspiratory muscle training on 1RM results. Methods This study included 14 athletes, that had participated in international bodybuilding competitions. Each athlete had been training for minimum of 5 years and at least 5 h per week. The participants were randomly divided into two groups: inspiratory muscle training (IMT) and control (CON) groups. The IMT group and CON group consisted of seven subjects. While the control group continued with the normal training regime, the IMT group additionally performed inspiratory muscle training with the resistance setting of the PowerBreathe® Classic device set to 40% of the participant's MIP. Prior to and during the 6-week training period, the bench press 1 RM, anthropometry, pulmonary function tests, and maximal inspiratory (MIP) and expiratory (MEP) pressure measurements were obtained. A nutrition protocol developed by a qualified dietician was implemented for each athlete. Results The mean maximal strength of the respiratory muscle training group changed by 14.39%, whereas that of the control group changed by 9.43% (p = 0.012). The changes in the mean FVC (p = 0.000), FEV1 (p = 0.001), PEF (p = 0.064), MIP (p = 0.001), and maximal expiratory pressure (p = 0.017) were greater in the IMT group. The mean circumferences of the shoulder (p = 0.004), chest (p = 0.008), arm (p = 0.004), and neck (p = 0.003) improved more in the IMT group than in the CON group. A reduction in abdominal measurement was observed in the IMT group (p = 0.039), whereas no notable discrepancy was identified in body fat percentage (p = 0.295). Conclusion In conclusion we identified that the addition of progressive loading inspiratory muscle training for competition preparation programs in professional natural bodybuilders will further improve their respiratory function, respiratory muscle strength, maximal strength, and muscle development. This research provides valuable insights into how IMT influences bodybuilding training outcomes, potentially guiding future interventions and program designs to better support strength development and body composition in bodybuilding training contexts.
Collapse
Affiliation(s)
| | - Coşkun Yılmaz
- Gümüşhane University, Kelkit Aydın Dogan VS, Gümüşhane, Türkiye
| | - Alper Demir
- Gümüşhane University, Kelkit Aydın Dogan VS, Gümüşhane, Türkiye
| | | | - Levent Ceylan
- Hitit University, Faculty of Sport Sciences, Çorum, Türkiye
| | - Tülay Ceylan
- Ondokuz Mayıs University, Graduate Education Institute, Samsun, Türkiye
| | - Çetin Tan
- Firat University, Faculty of Sport Sciences, Elazığ, Türkiye
| |
Collapse
|
|
5
|
Zhang Q, Liu H, Sun J, Shi H. Reducing stroke-associated pneumonia through pulmonary rehabilitation in moderate-to-severe acute ischemic stroke. Eur J Med Res 2025; 30:208. [PMID: 40140963 PMCID: PMC11948786 DOI: 10.1186/s40001-025-02451-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 03/10/2025] [Indexed: 03/28/2025] Open
Abstract
OBJECTIVES This study investigated the effect of a comprehensive pulmonary rehabilitation (CPR) program on stroke-associated pneumonia (SAP) in patients with moderate-to-severe acute ischemic stroke (AIS) after thrombolysis. METHODS This study was a prospective randomized controlled intervention study. Eighty patients with moderate-to-severe AIS were divided into the conventional rehabilitation (CR) and CPR groups. Demographic and general clinical data were collected. Patients were evaluated by the Fatigue Severity Scale (FSS), Fugl-Meyer Assessment (FMA), and Fugl-Meyer balance (FMB). The incidence of pneumonia in the acute phase and the treatment efficacy were compared. RESULTS FSS scores at T1 and T2 (2 weeks and 4 weeks after treatment), FMA scores, and FMB scores were higher than those at T0 (first day of admission). FSS scores in the CPR group were lower, while FMA and FMB scores were higher than those in the CR group at T1 and T2. The incidence of pneumonia was 10.00% in the CPR group and 25.00% in the CR group. The rehabilitation effective rate was 92.50% in the CPR group and 80.00% in the CR group, but the proportion of rehabilitation effect in the CPR group was higher than that in the CR group. CONCLUSIONS CPR program improves fatigue and motor function and reduces the occurrence of SAP in AIS patients.
Collapse
Affiliation(s)
- QingSha Zhang
- Department of Rehabilitation Medicine, Zibo Central Hospital, No. 54 Communist Youth League West Road, Zhangdian District, Zibo City, 255000, Shandong Province, China
| | - HongKun Liu
- Department of Integrative Medicine and Orthopaedics, Zibo Central Hospital, Zibo City, 255000, Shandong Province, China
| | - Jie Sun
- Department of Rehabilitation Medicine, Zibo Central Hospital, No. 54 Communist Youth League West Road, Zhangdian District, Zibo City, 255000, Shandong Province, China
| | - HongGe Shi
- Department of Rehabilitation Medicine, Zibo Central Hospital, No. 54 Communist Youth League West Road, Zhangdian District, Zibo City, 255000, Shandong Province, China.
| |
Collapse
|
|
6
|
Rancu AL, Katsnelson BM, Sanchez JG, Winter AD, Vasudevan RS, Grauer JN. Patients with fibromyalgia have increased risk of 90-day postoperative adverse events following arthroscopic rotator cuff repair. JSES Int 2025; 9:360-365. [PMID: 40182261 PMCID: PMC11962560 DOI: 10.1016/j.jseint.2024.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2025] Open
Abstract
Background Arthroscopic rotator cuff repair (RCR) is a common surgical intervention for symptomatic rotator cuff tears when conservative management fails. Understanding the potential correlation of short- and long-term outcomes associated with defined comorbidities can help with patient selection, counseling, and related care pathways. The association of fibromyalgia, one potential comorbidity, with outcomes following RCR has not been reported in the literature. Methods Patients with and without fibromyalgia diagnosed prior to undergoing RCR were identified from the PearlDiver Mariner161 database between 2016 and April 30, 2022, using Current Procedural Terminology codes. The exclusion criteria were age less than 18 years, a diagnosis of neoplasm, trauma, or infection within 90 days prior to surgery, and postoperative records of fewer than 90 days. Patients with and without fibromyalgia were matched in a 1:4 ratio based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events were assessed. Severe adverse events were defined as the occurrence of sepsis, surgical site infection, cardiac events, deep vein thrombosis, or pulmonary embolism. Minor adverse events were defined as the occurrence of wound dehiscence, urinary tract infection, pneumonia, transfusion, hematoma, or acute kidney injury. Also identified was the occurrence of any adverse event, emergency department (ED) visits, and readmission. These outcomes were compared with multivariate analysis. 1-year revisions were assessed with Kaplan-Meier curves and compared with the log-rank test. Results In total, 295,169 RCR patients were identified, of which fibromyalgia was noted for 12,366 (4.2%). Following matching, the final cohort sizes for those with and without fibromyalgia were 11,387 and 45,354, respectively. Diagnosis of fibromyalgia was independently associated with increased risk of all individual adverse events as well as aggregated incidence of severe, minor, and any adverse events (P < .0001 for all). Additionally, patients with fibromyalgia had independently 90-day increased odds of ED utilization (P < .0001). There was no statistically significant difference in reoperation between the cohorts within 1 year of surgery. Discussion and Conclusion Fibromyalgia was associated with significantly increased 90-day postoperative adverse events and ED visits. These findings are relevant in surgical planning but are also balanced by a lack of difference in 1-year revisions.
Collapse
Affiliation(s)
- Albert L. Rancu
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | | | - Joshua G. Sanchez
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | - Adam D. Winter
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | | | | |
Collapse
|
|
7
|
Zhao Q, Shao C, Wang Y, Zhao W, Wang L, Zhou W, Gou H, Mo Y, Chen T. The value of inspiratory muscle training on poststroke sarcopenia and its effect on rehabilitation outcomes: A randomized controlled trial. Turk J Phys Med Rehabil 2024; 70:476-485. [PMID: 40028407 PMCID: PMC11868859 DOI: 10.5606/tftrd.2024.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/08/2024] [Indexed: 03/05/2025] Open
Abstract
Objectives The purpose of the study was to validate the effectiveness of inspiratory muscle training (IMT) in preventing poststroke sarcopenia and to examine the impact of IMT on the prognosis for stroke recovery. Patients and methods In the randomized controlled trial, 367 patients with a first stroke event between December 2021 and May 2023 were randomly allocated to an experimental group and a control group. Of the patients, 329 (179 males, 150 females; mean age: 61.0±8.7 years; range, 35 to 78 years) completed the experiment and were included in the analyses (experimental group, n=164; control group, n=165). Both groups received conventional neurological rehabilitation treatment, and the experimental group also received IMT. The incidence of poststroke sarcopenia and pneumonia during four weeks of treatment were examined and compared. Additionally, an analysis was conducted on the variations between the two groups in maximal inspiratory pressure (MIP), modified Rankin scale (mRS), trunk impact scale (TIS), and modified Barthel index (MBI). Results Following four weeks of therapy, the experimental group experienced a reduced incidence of poststroke sarcopenia (p=0.004) and pneumonia (p=0.017) than the control group. The trial group performed better than the control group in MBI (p=0.002), TIS (p<0.001), MIP (p<0.001), and mRS (p=0.011) scores after intervention. Conclusion In conclusion, the findings demonstrate that early IMT can significantly lower the risk of poststroke sarcopenia and pneumonia while also improving the prognosis for stroke patients' recovery.
Collapse
Affiliation(s)
- Qianping Zhao
- The Rehabilitation Medicine Center, Peoples Hospital of Deyang City, Deyang, Sichuan Province, China
| | - Chenlan Shao
- The Rehabilitation Medicine Center, Peoples Hospital of Deyang City, Deyang, Sichuan Province, China
| | - Yongzheng Wang
- The Rehabilitation Medicine Center, Peoples Hospital of Deyang City, Deyang, Sichuan Province, China
| | - Weiwei Zhao
- The Rehabilitation Medicine Center, Peoples Hospital of Deyang City, Deyang, Sichuan Province, China
| | - Liang Wang
- The Rehabilitation Medicine Center, Peoples Hospital of Deyang City, Deyang, Sichuan Province, China
| | - Wei Zhou
- The Rehabilitation Medicine Center, Peoples Hospital of Deyang City, Deyang, Sichuan Province, China
| | - Hui Gou
- The Rehabilitation Medicine Center, Peoples Hospital of Deyang City, Deyang, Sichuan Province, China
| | - Yuxing Mo
- The Rehabilitation Medicine Center, Peoples Hospital of Deyang City, Deyang, Sichuan Province, China
| | - Tingting Chen
- The Rehabilitation Medicine Center, Peoples Hospital of Deyang City, Deyang, Sichuan Province, China
| |
Collapse
|
|
8
|
Rose DK, Brunetti G, Cavka K, Hoisington JB, Snyder H, Xue W, Smith BK. Respiratory Strength Training Versus Respiratory Relaxation Training in the Rehabilitation of Physical Impairment, Function, and Return to Participation After Stroke: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e59749. [PMID: 39602207 PMCID: PMC11635318 DOI: 10.2196/59749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND Persistent disability in chronic stroke survivors is often attributed to arm or leg weakness; however, respiratory muscle weakness also impedes poststroke rehabilitation, reduces quality of life, and increases the risk of health complications. Respiratory complications are common after stroke and place patients at risk for both prolonged functional disability and mortality. In addition, stroke survivors face ongoing cardiovascular disease that places them at risk for recurrent stroke. OBJECTIVE The study aims to compare the effects of 2 respiratory training programs, paired with individualized flexibility, strengthening, and cardiovascular exercise programs, on physiologic, activity, and societal participation outcomes in chronic stroke survivors. METHODS This study will be a randomized controlled trial. Participants are 80 community-dwelling adults with chronic stroke. In conjunction with a 24-session (3 times/week for 8 weeks), American Heart Association-informed, whole-body exercise program, participants will be randomized to receive either respiratory strength training or respiratory relaxation training. Study intervention will be directed by a physical therapist and take place in a community fitness center. Outcome assessments will occur in a clinical research center. The primary outcome measure is maximal respiratory pressure. Secondary outcome measures include airway clearance, walking endurance, spatial-temporal gait characteristics, community walking, functional strength and fatigue, depression, and societal participation measures. Longer-term societal participation is a complex domain that may be influenced by other factors beyond physical function. Participants' health status will be monitored for 1 year following the intervention for falls, respiratory illness, and hospitalizations. Additional subanalyses will evaluate the effect of smoke exposure on short- and long-term outcomes. Outcome assessors are blinded to group assignments. Respiratory relaxation training is an active comparator, but no pure control group is included. RESULTS This study was funded in March 2020 with enrollment commencing in November 2020. Completion of enrollment is projected for May 2025 with a study projected end date of April 2026. Published results are anticipated in Fall 2026. CONCLUSIONS Results from this study will improve our understanding of the additive benefits of respiratory exercises on short- and long-term physiologic, functional, and societal gains for these individuals. These data will be instructive to meet a current unmet rehabilitative need to promote patient-centered care and contribute to decreasing morbidity and mortality in chronic stroke survivors. TRIAL REGISTRATION ClinicalTrials.gov: NCT05819333; https://clinicaltrials.gov/study/NCT05819333. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/59749.
Collapse
Affiliation(s)
- Dorian K Rose
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
- Brooks Rehabilitation, Jacksonville, FL, United States
- Brain Rehabilitation Research Center, Malcom Randall VAMC, Gainesville, FL, United States
| | - Gina Brunetti
- Brooks Rehabilitation, Jacksonville, FL, United States
| | - Kathryn Cavka
- Brooks Rehabilitation, Jacksonville, FL, United States
| | | | - Hannah Snyder
- Brooks Rehabilitation, Jacksonville, FL, United States
| | - Wei Xue
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - Barbara K Smith
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| |
Collapse
|
|
9
|
Doğan YE, Yıldırım MA, Öneş K, Kütük B, Ata İ, Karacan İ. The optimal treatment duration for inspiratory muscle strengthening exercises in stroke patients: a double-blinded randomized controlled trial. Top Stroke Rehabil 2024:1-9. [PMID: 39495832 DOI: 10.1080/10749357.2024.2423591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 10/27/2024] [Indexed: 11/06/2024]
Abstract
BACKGROUND Little is known about the ideal duration of inspiratory muscle training in stroke patients. OBJECTIVE The aim of this study was to assess the effects of short-term and long-term inspiratory muscle strengthening exercises in stroke patients. METHODS This study was a prospective, double-blind, randomized controlled trial involving 50 stroke patients. Based on baseline maximum inspiratory pressure (MIP) values, participants were divided into two strata: those with severely weak inspiratory muscle (stratum A) and those with moderately weak inspiratory muscle (stratum B). Within each stratum, individuals were randomly assigned to either the 4-week exercise group, the 8-week exercise group, or the sham group. The exercise groups underwent inspiratory muscle strengthening exercises. The MIP, 6-minute walk test (6MWT), and the Nottingham Extended Activities of Daily Living (NEADL) Index were assessed at baseline, 8, 12, and 24 weeks. RESULTS Subjects in Stratum A exhibited notably greater improvement after 8 weeks of training compared to those in Stratum B. Furthermore, both Stratums displayed significantly greater improvement following 8 weeks of training compared to sham training. In Stratum B cases, a significantly higher level of improvement was noted with the 4-week training in comparison to the sham training. A significant increase in NEADL index and 6MWT score was observed during the 24-week follow-up period. CONCLUSION For individuals with moderately weak inspiratory muscle strength, a 4-week exercise program proves sufficient in enhancing inspiratory muscle strength, walking capacity, and daily life activities. However, individuals with severely weak inspiratory muscle strength benefit more from an 8-week treatment.
Collapse
Affiliation(s)
- Yunus Emre Doğan
- Department of Physical Medicine and Rehabilitation, Saglik Bilimleri University Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Aziz Yıldırım
- Department of Physical Medicine and Rehabilitation, Saglik Bilimleri University Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Kadriye Öneş
- Department of Physical Medicine and Rehabilitation, Saglik Bilimleri University Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Burak Kütük
- Department of Physical Medicine and Rehabilitation, Saglik Bilimleri University Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - İlhami Ata
- Department of Physical Medicine and Rehabilitation, Saglik Bilimleri University Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - İlhan Karacan
- Department of Physical Medicine and Rehabilitation, Saglik Bilimleri University Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
|
10
|
Lee J, Kim J. Effect of chest expansion resistance exercise and respiratory muscle stretching on respiratory function and gait endurance in patients with stroke. NeuroRehabilitation 2024:NRE240132. [PMID: 39485712 DOI: 10.3233/nre-240132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2024]
Abstract
BACKGROUND Limited chest expansion and asymmetry in the respiratory muscles after a stroke lead to poor ventilation and reduced physical performance. OBJECTIVES To determine the effect of chest expansion resistance exercise and respiratory muscle stretching on respiratory function and gait endurance in patients with stroke. METHODS Thirty stroke patients were randomly assigned to a chest expansion resistance group (CERG), a respiratory muscle stretching group (RMSG), and a control group (CG). CERG and RMSG received chest expansion resistance and respiratory muscle stretching, respectively, 3 times a week for 8 weeks. Respiratory function, respiratory muscle strength, and gait endurance were measured before and after the intervention period. RESULTS The experimental groups, CERG and RMSG, showed significant improvements in respiratory function variables (p < .05). For respiratory muscle strength variables, maximal inspiratory pressure (MIP) in the CERG and maximal expiratory pressure (MEP) in the RMSG showed significant changes compared to the CG (p < .05). Both CERG and RMSG also showed significant improvements in the 6MWT compared to the CG (p < .05). CONCLUSION Chest expansion resistance exercise would be a more effective method, while both chest expansion resistance exercise and respiratory muscle stretching are helpful in improving respiratory function and gait endurance.
Collapse
Affiliation(s)
- Jiyeon Lee
- Digital Healthcare Institute, Sunmoon University, Asan, Republic of Korea
| | - Jinseop Kim
- Department of Physical Therapy, Sunmoon University, Asan, Republic of Korea
| |
Collapse
|
|
11
|
Kim SH, Cho SH. Effects of cardiorespiratory physiotherapy on lung function in stroke: a network meta-analysis. Top Stroke Rehabil 2024:1-13. [PMID: 39436741 DOI: 10.1080/10749357.2024.2417647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 10/13/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND The efficacy of various physiotherapy interventions for improving lung function has not been compared. OBJECTIVES To evaluate cardiorespiratory physiotherapy interventions on lung function in patients with stroke, prioritize intervention types, and establish hierarchy. METHODS Twelve randomized controlled trials published during 2000-2022 in PubMed, EMBASE, Cochrane Library, and Web of Science were selected. Interventions included aerobic training (AT), combined inspiratory and expiratory training (CIET), inspiratory training (IT), combined aerobic and breadth training (CABT), and conventional training (CT). Outcome variables were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC. RESULTS CIET and IT were more effective than CT for FEV1 and FVC. CIET and IT showed larger effect sizes compared to AT for FEV1. The intervention rankings were as follows: IT (86.62%), CIET (63.31%), CABT (50.79%), AT (28.72%), and CT (20.55%) for FEV1; IT (93.89%), CIET (75.06%), CT (42.38%), CABT (37.73%), and AT (0.94%) for FVC; and IT (78.30%), CT (54.14%), CABT (42.62%), CIET (41.65%), and AT (33.29%) for FEV1/FVC. CIET and IT were more effective than CT for FVC in patients with stroke aged ≥60 years. CONCLUSIONS Besides FEV1/FVC, IT and CIET inhalation exercises improved lung function more effectively than other therapies, with IT or CIET being more effective than AT or CT. CIET and IT were more effective than CT for FVC in patients with stroke aged ≥60 years than in those <60 years. These findings highlight the significance of breathing training for patients with stroke and support clinical decision-making.
Collapse
Affiliation(s)
- So-Hyun Kim
- Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju, Republic of Korea
| | - Sung-Hyoun Cho
- Department of Physical Therapy, Nambu University, Gwangju Republic of Korea
| |
Collapse
|
|
12
|
He Y, Wang X, Huang T, Zhao W, Fu Z, Zheng Q, Jin L, Kim H, Liu H. The Study of Speech Acoustic Characteristics of Elderly Individuals with Presbyphagia in Ningbo, China. J Voice 2024:S0892-1997(24)00334-5. [PMID: 39414424 DOI: 10.1016/j.jvoice.2024.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 09/22/2024] [Accepted: 09/23/2024] [Indexed: 10/18/2024]
Abstract
The feasibility of using acoustic parameters to predict presbyphagia has been preliminarily confirmed. Considering that age and gender can influence the results of acoustic parameters, this study aimed to further explore the specific effects of age and gender on acoustic parameter analysis of the elderly population over 60 years old with presbyphagia. A total of 45 participants were enrolled and divided into three groups (60-69 years old, 70-79 years old, and 80-89 years old). Acoustic parameters, including maximum phonation time, first to third formant frequencies (F1-F3) of /a/, /i/, and /u/, oral diadochokinesis, the acoustic vowel space, and laryngeal diadochokinesis (LDDK), were extracted and calculated. Two-way analysis of variance was used to analyze the correlations between acoustic parameters and age and gender. The result indicates that /hʌ/ LDDK rate had significant differences in age groups, presenting the 80-89 age group being significantly slower than the 60-69 age group. F1/a/, F2/a/, F2/i/, F3/i/, and F2i/F2u differed systematically between genders, with males being lower and smaller than females. Changes that were consistent with /hʌ/ LDDK regularity, confirmed by greater regularity in females. No significant differences were observed for other acoustic parameters. No significant interactions were revealed. According to the preliminary data, we hypothesized that respiratory capacity and control during vocal fold abduction weaken with aging. This highlights the importance of continuously monitoring the respiratory impact on swallowing function in elderly individuals. Additionally, gender influenced several acoustic parameters, indicating the necessity to differentiate between genders when assessing presbyphagia using acoustic parameters, especially focusing on swallowing function in elderly males in Ningbo.
Collapse
Affiliation(s)
- YuHan He
- Faculty of Education, Beijing Normal University, Beijing, China; Department of Rehabilitation Sciences, East China Normal University, Shanghai, China
| | - XiaoYu Wang
- Department of Rehabilitation Sciences, East China Normal University, Shanghai, China
| | - TianYi Huang
- Department of Rehabilitation Sciences, East China Normal University, Shanghai, China
| | - WenSheng Zhao
- Department of Rehabilitation Sciences, East China Normal University, Shanghai, China
| | - Zhen Fu
- Department of Rehabilitation, Shanghai Tongren Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Zheng
- Department of Women and Children's Health Care, Shanghai First Maternity and Infant Hospital, Obstetrics and Gynecology Hospital of Tongji University, Shanghai, China
| | - LingJing Jin
- Department of Neurology and Neurological Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - HaKyung Kim
- Department of Rehabilitation Sciences, East China Normal University, Shanghai, China.
| | - HengXin Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing, China; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| |
Collapse
|
|
13
|
Liu F, Jones AYM, Tsang RCC, Yam TTT, Hao Y, Tsang WWN. Effects of inspiratory muscle training on pulmonary function, diaphragmatic thickness, balance and exercise capacity in people after stroke: a systematic review and meta-analysis. Disabil Rehabil 2024:1-16. [PMID: 39363485 DOI: 10.1080/09638288.2024.2408606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 09/14/2024] [Accepted: 09/17/2024] [Indexed: 10/05/2024]
Abstract
PURPOSE To examine the effects of inspiratory muscle training (IMT) on pulmonary and diaphragmatic function, exercise capacity, balance and quality of life (QOL), in post-stroke individuals. METHODS A literature search was conducted using MEDLINE, CINAHL, EMBASE, PubMed, PEDro, Web of Science and China Biological Medicine databases. Randomized controlled trials (RCTs) with a PEDro score ≥6 focusing on the effects of IMT were included. The GRADE system was used to determine the certainty of evidence for each outcome. RESULTS Nine studies (255 participants) were included. IMT significantly increased forced expiratory volume in one second (FEV1) (4 studies, 112 participants, mean difference (MD)=0.18 litre, 95% confidence interval (CI): 0.14-0.23); maximal inspiratory pressure (MIP) (8 studies, 226 participants, MD = 6.37 cm H2O, 95% CI: 1.26-11.49); and diaphragm thickness fraction (DTf) on both sides (MD of affected side vs. unaffected side: 51 vs. 37%). The evidence certainty for diaphragmatic function was moderate. No significant change was observed in forced vital capacity (FVC), balance function, exercise capacity and QOL. CONCLUSION This review reveals moderate evidence certainty in support of IMT improving diaphragmatic function. It appears that a training intensity between 30 and 50% MIP results in a significantly improved MIP.
Collapse
Affiliation(s)
- Fang Liu
- Department of Physiotherapy, School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, China
| | - Alice Y M Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
| | - Raymond C C Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Timothy T T Yam
- Department of Physiotherapy, School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, China
| | - Yingzi Hao
- School of Rehabilitation Medicine, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - William W N Tsang
- Department of Physiotherapy, School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, China
| |
Collapse
|
|
14
|
Fonseca EG, Araújo-Ferreira AP, Berger M, Castro Coimbra-Campos LM, Silva Filha R, de Souza Cordeiro LM, Campos MR, Oliveira LBF, Caliari MV, Leite Diniz LR, Alves F, Martins AS, Peruchetti DB, Ribeiro Vieira MA. Preconditioning by Moderate-Intensity Exercise Prevents Gentamicin-Induced Acute Kidney Injury. Int J Sports Med 2024; 45:884-896. [PMID: 39029513 DOI: 10.1055/a-2342-2154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
A strict correlation among proximal tubule epithelial cell dysfunction, proteinuria, and modulation of the Renin-Angiotensin System and Kalikrein-Kinin System are crucial factors in the pathogenesis of Acute Kidney Injury (AKI). In this study, we investigated the potential protective effect of preconditioning by moderate-intensity aerobic exercise on gentamicin-induced AKI. Male Wistar rats were submitted to a moderate-intensity treadmill exercise protocol for 8 weeks, and then injected with 80 mg/kg/day s.c. gentamicin for 5 consecutive days. Four groups were generated: 1) NT+SAL (control); 2) NT+AKI (non-trained with AKI); 3) T+SAL (trained); and 4) T+AKI (trained with AKI). The NT+AKI group presented: 1) impairment in glomerular function parameters; 2) increased fractional excretion of Na + , K + , and water; 4) proteinuria and increased urinary γ-glutamyl transferase activity (a marker of tubular injury) accompanied by acute tubular necrosis; 5) an increased renal angiotensin-converting enzyme and bradykinin B1 receptor mRNA expression. Interestingly, the preconditioning by moderate-intensity aerobic exercise attenuated all alterations observed in gentamicin-induced AKI (T+AKI group). Taken together, our results show that the preconditioning by moderate-intensity aerobic exercise ameliorates the development of gentamicin-induced AKI. Our findings help to expand the current knowledge regarding the effect of physical exercise on kidneys during physiological and pathological conditions.
Collapse
Affiliation(s)
- Esdras Guedes Fonseca
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Markus Berger
- Hospital das Clinicas, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Roberta Silva Filha
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Mariana Rodrigues Campos
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Fabiana Alves
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Almir Souza Martins
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Diogo Barros Peruchetti
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Brazil
- INCT-NanoBiofar, Belo Horizonte, Brazil
| | | |
Collapse
|
|
15
|
Poddighe D, Van Hollebeke M, Rodrigues A, Hermans G, Testelmans D, Kalkanis A, Clerckx B, Gayan-Ramirez G, Gosselink R, Langer D. Respiratory muscle dysfunction in acute and chronic respiratory failure: how to diagnose and how to treat? Eur Respir Rev 2024; 33:240150. [PMID: 39631928 PMCID: PMC11615664 DOI: 10.1183/16000617.0150-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/19/2024] [Indexed: 12/07/2024] Open
Abstract
Assessing and treating respiratory muscle dysfunction is crucial for patients with both acute and chronic respiratory failure. Respiratory muscle dysfunction can contribute to the onset of respiratory failure and may also worsen due to interventions aimed at treatment. Evaluating respiratory muscle function is particularly valuable for diagnosing, phenotyping and assessing treatment efficacy in these patients. This review outlines established methods, such as measuring respiratory pressures, and explores novel techniques, including respiratory muscle neurophysiology assessments using electromyography and imaging with ultrasound.Additionally, we review various treatment strategies designed to support and alleviate the burden on overworked respiratory muscles or to enhance their capacity through training interventions. These strategies range from invasive and noninvasive mechanical ventilation approaches to specialised respiratory muscle training programmes. By summarising both established techniques and recent methodological advancements, this review aims to provide a comprehensive overview of the tools available in clinical practice for evaluating and treating respiratory muscle dysfunction. Our goal is to present a clear understanding of the current capabilities and limitations of these diagnostic and therapeutic approaches. Integrating advanced diagnostic methods and innovative treatment strategies should help improve patient management and outcomes. This comprehensive review serves as a resource for clinicians, equipping them with the necessary knowledge to effectively diagnose and treat respiratory muscle dysfunction in both acute and chronic respiratory failure scenarios.
Collapse
Affiliation(s)
- Diego Poddighe
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium
- D. Poddighe and M. Van Hollebeke contributed equally to the manuscript and are shared first authors
| | - Marine Van Hollebeke
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium
- D. Poddighe and M. Van Hollebeke contributed equally to the manuscript and are shared first authors
| | - Antenor Rodrigues
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Greet Hermans
- University Hospitals Leuven, Department of General Internal Medicine, Medical Intensive Care Unit, Leuven, Belgium
- Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Dries Testelmans
- University Hospitals Leuven, Department of Respiratory Medicine, Leuven, Belgium
| | - Alexandros Kalkanis
- University Hospitals Leuven, Department of Respiratory Medicine, Leuven, Belgium
| | - Beatrix Clerckx
- University Hospitals Leuven, Department of General Internal Medicine, Medical Intensive Care Unit, Leuven, Belgium
- Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- KU Leuven, Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Leuven, Belgium
| | - Rik Gosselink
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium
- Department of Health and Rehabilitation Sciences - Faculty of Medicine, Stellenbosch University, South Africa
| | - Daniel Langer
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium
| |
Collapse
|
|
16
|
Yildiz A, Mustafaoglu R, Bardak AN. Respiratory muscle strength in stroke: a case-control study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240061. [PMID: 39166672 PMCID: PMC11329255 DOI: 10.1590/1806-9282.20240061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 08/23/2024]
Abstract
AIM The aim of the study was to determine the respiratory muscle strength of stroke patients and compare them with healthy individuals. METHOD The study was conducted with 171 patients who had a stroke between 2017 and 2021 and 32 healthy controls. Respiratory muscle strength and inspiratory and expiratory mouth pressure (MIP and MEP) were measured using the portable MicroRPM device (Micro Medical, Basingstoke, UK). RESULTS The stroke group exhibited significantly lower values in both MIP for men (p<0.001) and women (p=0.013) and maximal expiratory pressure for men (p<0.001) and women (p=0.042), compared with the healthy control group. Notably, there was a significant difference in the MIPmen (p=0.026) and MEPmen (p=0.026) values when comparing the reference values, which were calculated based on age and sex, with those of the healthy group. The baseline values calculated according to age for stroke patients were as follows: MIPmen 31.68%, MIPwomen 63.58%, MEPmen 22.54%, and MEPwomen 42.30%. CONCLUSION This study highlights the significant respiratory muscle weakness experienced by stroke patients, with gender-specific differences. It highlights the importance of incorporating respiratory assessments and interventions into stroke rehabilitation protocols to improve the overall health and well-being of stroke patients.
Collapse
Affiliation(s)
- Abdurrahim Yildiz
- Sakarya University of Applied Sciences, Department of Physiotherapy and Rehabilitation - Sakarya, Turkey
| | - Rustem Mustafaoglu
- Istanbul University - Cerrahpasa, Department of Physiotherapy and Rehabilitation - İstanbul, Turkey
| | - Ayse Nur Bardak
- University of Health Sciences, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital - İstanbul, Turkey
| |
Collapse
|
|
17
|
Liu YT, Liu XX, Liu YQ, Zhang L, Zhang LJ, Wang JH, Shi Y, Xie QF. Effects of respiratory muscle training on post-stroke rehabilitation: A systematic review and meta-analysis. World J Clin Cases 2024; 12:4289-4300. [PMID: 39015926 PMCID: PMC11235562 DOI: 10.12998/wjcc.v12.i20.4289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Stroke often results in significant respiratory dysfunction in patients. Respiratory muscle training (RMT) has been proposed as a rehabilitative intervention to address these challenges, but its effectiveness compared to routine training remains debated. This systematic review and meta-analysis aim to evaluate the effects of RMT on exercise tolerance, muscle strength, and pulmonary function in post-stroke patients. AIM To systematically assess the efficacy of RMT in improving exercise tolerance, respiratory muscle strength, and pulmonary function in patients recovering from a stroke, and to evaluate whether RMT offers a significant advantage over routine training modalities in enhancing these critical health outcomes in the post-stroke population. METHODS Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library was conducted on October 19, 2023, without temporal restrictions. Studies were selected based on the predefined inclusion and exclusion criteria focusing on various forms of RMT, control groups, and outcome measures [including forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), maximal voluntary ventilation (MVV), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and 6-min walking test (6MWT)]. Only randomized controlled trials (RCTs) were included. Data extraction and quality assessment were conducted independently by two reviewers using the Cochrane Collaboration's risk of bias tool. Statistical analyses, including those using the fixed-effect and random-effects models, sensitivity analysis, and publication bias assessment, were performed using Review Manager software. RESULTS A total of 15 RCTs were included. Results indicated significant improvements in MIP (12.51 cmH2O increase), MEP (6.24 cmH2O increase), and various pulmonary function parameters (including FEV1, FVC, MVV, and PEF). A substantial increase in 6MWT distance (22.26 meters) was also noted. However, the heterogeneity among studies was variable, and no significant publication bias was detected. CONCLUSION RMT significantly enhances walking ability, respiratory muscle strength (MIP and MEP), and key pulmonary function parameters (FEV1, FVC, MVV, and PEF) in post-stroke patients. These findings support the incorporation of RMT into post-stroke rehabilitative protocols.
Collapse
Affiliation(s)
- Yong-Tao Liu
- Department of Rehabilitation, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Xiao-Xin Liu
- Ophthalmologist Clinic, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Yi-Qing Liu
- Department of Cardiology, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Lei Zhang
- Department of Ultrasound, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Lin-Jing Zhang
- Department of Rehabilitation, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Jian-Hua Wang
- Department of Rehabilitation, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Yan Shi
- Department of Rehabilitation, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Qing-Fan Xie
- Department of Rehabilitation, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| |
Collapse
|
|
18
|
Chen X, Hu S, Jia X, Zeng B. Incremental Load Respiratory Muscle Training Improves Respiratory Muscle Strength and Pulmonary Function in Children with Bronchiectasis. Can Respir J 2024; 2024:8884030. [PMID: 38818499 PMCID: PMC11139531 DOI: 10.1155/2024/8884030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 01/22/2024] [Accepted: 05/11/2024] [Indexed: 06/01/2024] Open
Abstract
Methods Participants underwent respiratory muscle training for 24 weeks. The main results were changes in respiratory muscle strength and pulmonary function indices (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow rate (PEF), forced expiratory flow 25-75% (FEF25-75%), and maximal midexpiratory flow 75/25 (MMEF75/25)) before, 12 weeks after, and 24 weeks after the intervention. The secondary outcomes were changes in the exercise load and work rate, exercise work, Leicester Cough Questionnaire (LCQ) scale, and Fatigue Severity Scale (FSS). Results Compared with before the intervention, after 24 weeks of respiratory muscle training, the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were significantly enhanced (P < 0.05), while FVC, FEV1, and PEF were significantly increased (P < 0.01). FEF25-75 and MMEF75/25 values showed significant improvement compared to those before training (P < 0.05). The exercise loading, work, and exercise work rate of expiratory muscle training were significantly improved compared to those before intervention (P < 0.05). The LCQ score increased significantly (P < 0.001), and the FSS score decreased significantly (P < 0.001). Conclusion Incremental load respiratory muscle training effectively improved children's lung function over the long term, improved the strength of their inspiratory and expiratory muscles, and improved their quality of life.
Collapse
Affiliation(s)
- Xiaolong Chen
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Shidong Hu
- Department of Pediatric Respiratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Xiaohui Jia
- Department of Pediatric Respiratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Bingbing Zeng
- Center of Traditional Chinese Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| |
Collapse
|
|
19
|
Yildiz A, Demir R, Mustafaoglu R, Erkut U, Kesiktas FN. Structured different exercise protocols improve lung function, respiratory muscle strength, and thickness in stroke patients. A randomized controlled trial. Top Stroke Rehabil 2024:1-13. [PMID: 38780025 DOI: 10.1080/10749357.2024.2356413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The effect of core stabilization exercises (CSE) alone, or in combination with neuromuscular electrical stimulation (NMES) and Kinesio taping (KT) on lung function, respiratory muscle strength, and thickness in patients with stroke is not fully known. OBJECTIVE To compare the efficacy of NMES and KT applied with CSE on lung functions, respiratory muscle strength, and thickness in patients with stroke. METHODS A total of 45 stroke patients were randomly assigned to the core stabilization exercises (CSE) group, CSE+KT group or CSE+NMES group, respectively. All groups received the training protocol for 30-45 minutes, 3 days a week, for 6 weeks. Lung functions were measured using portable spirometry. Respiratory muscle strength was assessed using an analog manometer to measure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Peak cough flow (PCF) was measured with a peak flow meter. Respiratory muscles thickness were determined using ultrasonography. RESULTS Except for FVC (%pred) (F=4.432, p=0.018, np2=0.174), FEV1(%pred) (F=3.725, p=0.032, np2=0.151), and MEP (F=3.861, p=0.029, np2=0.155), the overall group by time interaction for rmANOVA showed that there was no statistically significant difference between groups (p>0.05). After post hoc analysis, it was determined that there was no statistically significant difference between the groups in terms of FVC (%pred), FEV1(%pred) and MEP (p>0.025). CONCLUSIONS The addition of NMES or KT to core stabilization exercises did not appear to provide additional benefit in improving lung function, respiratory muscle strength, and thickness in stroke patients.
Collapse
Affiliation(s)
- Abdurrahim Yildiz
- Department of Physiotherapy and Rehabilitation, Sakarya University of Applied Sciences, Sakarya, Türkiye
| | - Rengin Demir
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Rustem Mustafaoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Umit Erkut
- Department of Physiotherapy and Rehabilitation, Rumeli University, Istanbul, Türkiye
| | - Fatma Nur Kesiktas
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| |
Collapse
|
|
20
|
Hao X, Yang Y, Qin Y, Lv M, Zhao X, Wu S, Li K. The Effect of Respiratory Muscle Training on Swallowing Function in Patients With Stroke: A Systematic Review and Meta-Analysis. West J Nurs Res 2024; 46:389-399. [PMID: 38545931 DOI: 10.1177/01939459241242533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND The improvement of swallowing function after stroke is a significant challenge faced by patients and health care professionals. However, the current evidence synthesis of the effects of respiratory muscle training (RMT) on swallowing function is limited. OBJECTIVE To assess the effectiveness of RMT on swallowing recovery in patients undergoing stroke. METHODS The CKNI, WanFang Data, PubMed, CINAHL, Web of Science, Embase, MEDLINE, and Cochrane Library databases were searched for studies evaluating RMT interventions' effect on swallowing outcomes. Risks of bias were evaluated using the approach recommended by the Cochrane Collaboration tool and a summary of findings table was generated using the GRADE approach. Outcomes were synthesized using a random-effects meta-analysis model. RESULTS RMT interventions reduced the risk of aspiration (SMD = 1.19; 95% CI, 0.53-1.84), the recovery process of water swallowing function (RR = 1.22; 95% CI, 1.05-1.42), and the activity of the swallowing muscles (SMD = 2.91; 95% CI, 2.22-3.61). However, there was no significant effect of RMT on the functional level of oral intake (SMD = 0.70; 95% CI, -0.03 to 1.42). CONCLUSIONS RMT can be regarded as an innovative, auxiliary means in the near future to better manage and improve swallowing function, given its improving effect on work outcomes in this review.
Collapse
Affiliation(s)
- Xiaonan Hao
- School of Nursing, Jilin University, Changchun, China
| | - Yuhang Yang
- School of Nursing, Jilin University, Changchun, China
| | - Yuan Qin
- School of Nursing, Jilin University, Changchun, China
| | - Miaohua Lv
- School of Nursing, Jilin University, Changchun, China
| | - Xuetong Zhao
- School of Nursing, Jilin University, Changchun, China
| | - Shuang Wu
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
| |
Collapse
|
|
21
|
Menezes KKP, Avelino PR, Alvarenga MTM, Nascimento LR. Inspiratory Training for Improving Respiratory Strength, Pulmonary Function, and Walking in Cerebral Palsy: A Meta-Analysis. Pediatr Phys Ther 2024; 36:207-215. [PMID: 38568267 DOI: 10.1097/pep.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE To investigate the effects of inspiratory strength training on respiratory muscle strength, pulmonary function, and walking capacity in children with cerebral palsy, with Gross Motor Function Classification System I to III. METHODS Searches were conducted in CINAHL, LILACS, MEDLINE, and Physiotherapy Evidence Database (PEDro) databases. The outcomes of interest were respiratory muscle strength, pulmonary function, and walking capacity. The quality was assessed by PEDro Scale. The Grading of Recommendations Assessment, Development, and Evaluation system was used to summarize the quality of evidence. RESULTS Inspiratory strength training increased the strength of inspiratory muscles and may increase the strength of the expiratory muscles. No changes were observed in pulmonary function or walking capacity. CONCLUSIONS This systematic review provides moderate-quality evidence that inspiratory strength training is effective for increasing inspiratory muscle strength in children with cerebral palsy. Benefits may be carried over to improving expiratory muscle strength but were not observed on pulmonary function or walking capacity.
Collapse
Affiliation(s)
- Kênia K P Menezes
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Drs Menezes and Avelino and Ms Alvarenga); Department of Physical Therapy, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil (Dr Nascimento)
| | | | | | | |
Collapse
|
|
22
|
Dai Y, Cai J, Wang H, Zhang Y, Niu C, Wang Y. Effect of respiratory training on swallowing function in swallowing disorders: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:1069-1081. [PMID: 37843618 PMCID: PMC10858149 DOI: 10.1007/s00405-023-08280-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE To determine the clinical efficacy of different respiratory training interventions on swallowing function in patients with swallowing disorders through the systematic review. METHODS We reviewed the literature regarding the application of respiratory training therapy in patients with swallowing disorders, followed by a PRISMA search of published literature in five databases (PubMed, Web of Science, The Cochrane Library, CINAHL and EMBASE) in December 2022. Two reviewers performed study selection, quality evaluation, and risk of bias, followed by data extraction and detailed analysis. RESULTS A total of six randomized controlled studies with a total sample size of 193 cases were included. Respiratory training improved swallowing safety (PAS (n = 151, SMD = 0.69, 95% CI - 1.11 to - 0.26, I2 = 36, p < 0.001)) and swallowing efficiency [residual (n = 63, SMD = 1.67, 95% CI - 2.26 to - 1.09, I2 = 23%, p < 0.001)] compared to control groups. The results of the qualitative analysis conducted in this study revealed that respiratory training enhanced hyoid bone movement but had no effect on swallowing quality of life. CONCLUSIONS Respiratory training interventions may improve swallowing safety and efficiency in patients with dysphagia. However, the level of evidence is low, and there is a limited amount of research on the effectiveness and physiology of this intervention to improve swallowing function. In the future, there is a need to expand clinical studies, standardize measurement tools, and improve study protocols.
Collapse
Affiliation(s)
- Yinuo Dai
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Jianzheng Cai
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Haifang Wang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Yingying Zhang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Chunyan Niu
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yalan Wang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| |
Collapse
|
|
23
|
Zhang YS, Zhang K, Huang L, Wei JX, Bi ZT, Xiao JH, Huang J, Luo CS, Li YD, Zhang JM. The effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke: a meta-analysis. Eur Rev Aging Phys Act 2024; 21:4. [PMID: 38383309 PMCID: PMC10882726 DOI: 10.1186/s11556-024-00338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Respiratory muscle training is a continuous and standardized training of respiratory muscles, but the evidence of the effects on early stroke patients is not clear. This meta-analysis aimed to investigate the effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke. METHODS PubMed, Embase, PEDro, ScienceDirect, AMED, CINAHL, and China National Knowledge Infrastructure databases were searched from inception to December 8, 2023 for articles about studies that 1) stroke patients with age ≥ 18 years old. Early stroke < 3 months at the time of diagnosis, 2) respiratory muscle training, including inspiratory and expiratory muscle training, 3) the following measurements are the outcomes: respiratory muscle strength, respiratory muscle endurance, pulmonary function testing, dyspnea fatigue score, and functional capacity, 4) randomized controlled trials. Studies that met the inclusion criteria were extracted data and appraised the methodological quality and risk of bias using the Physiotherapy Evidence Database scale and the Cochrane Risk of Bias tool by two independent reviewers. RevMan 5.4 with a random effect model was used for data synthesis and analysis. Mean differences (MD) or standard mean differences (SMD), and 95% confidence interval were calculated (95%CI). RESULTS Nine studies met inclusion criteria, recruiting 526 participants (mean age 61.6 years). Respiratory muscle training produced a statistically significant effect on improving maximal inspiratory pressure (MD = 10.93, 95%CI: 8.51-13.36), maximal expiratory pressure (MD = 9.01, 95%CI: 5.34-12.69), forced vital capacity (MD = 0.82, 95%CI: 0.54-1.10), peak expiratory flow (MD = 1.28, 95%CI: 0.94-1.63), forced expiratory volume in 1 s (MD = 1.36, 95%CI: 1.13-1.59), functional capacity (SMD = 0.51, 95%CI: 0.05-0.98) in patients with early stroke. Subgroup analysis showed that inspiratory muscle training combined with expiratory muscle training was beneficial to the recovery of maximal inspiratory pressure (MD = 9.78, 95%CI: 5.96-13.60), maximal expiratory pressure (MD = 11.62, 95%CI: 3.80-19.43), forced vital capacity (MD = 0.87, 95%CI: 0.47-1.27), peak expiratory flow (MD = 1.51, 95%CI: 1.22-1.80), forced expiratory volume in 1 s (MD = 0.76, 95%CI: 0.41-1.11), functional capacity (SMD = 0.61, 95%CI: 0.08-1.13), while inspiratory muscle training could improve maximal inspiratory pressure (MD = 11.60, 95%CI: 8.15-15.05), maximal expiratory pressure (MD = 7.06, 95%CI: 3.50-10.62), forced vital capacity (MD = 0.71, 95%CI: 0.21-1.21), peak expiratory flow (MD = 0.84, 95%CI: 0.37-1.31), forced expiratory volume in 1 s (MD = 0.40, 95%CI: 0.08-0.72). CONCLUSIONS This study provides good-quality evidence that respiratory muscle training is effective in improving respiratory muscle strength, pulmonary function, and functional capacity for patients with early stroke. Inspiratory muscle training combined with expiratory muscle training seems to promote functional recovery in patients with early stroke more than inspiratory muscle training alone. TRIAL REGISTRATION Prospero registration number: CRD42021291918.
Collapse
Affiliation(s)
- Yun-Shan Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
| | - Kai Zhang
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, 310016, China
| | - Lang Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jing-Xue Wei
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Zi-Ting Bi
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jing-Hua Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jian Huang
- Cardiopulmonary Rehabilitation Center, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530000, China
| | - Chao-Song Luo
- Cardiopulmonary Rehabilitation Center, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530000, China
| | - Ying-Dong Li
- Department of Rehabilitation Medicine, The Guangxi Zhuang Autonomous Region Workers' Hospital, Nanning, 530000, China
| | - Jia-Mei Zhang
- Department of Rehabilitation Medicine, Guangxi International Zhuang Medicine Hospital, NanningNanning, 530000, China
| |
Collapse
|
|
24
|
Drakopanagiotakis F, Bonelis K, Steiropoulos P, Tsiptsios D, Sousanidou A, Christidi F, Gkantzios A, Serdari A, Voutidou S, Takou CM, Kokkotis C, Aggelousis N, Vadikolias K. Pulmonary Function Tests Post-Stroke. Correlation between Lung Function, Severity of Stroke, and Improvement after Respiratory Muscle Training. Neurol Int 2024; 16:139-161. [PMID: 38251057 PMCID: PMC10801624 DOI: 10.3390/neurolint16010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Stroke is a significant cause of mortality and chronic morbidity caused by cardiovascular disease. Respiratory muscles can be affected in stroke survivors, leading to stroke complications, such as respiratory infections. Respiratory function can be assessed using pulmonary function tests (PFTs). Data regarding PFTs in stroke survivors are limited. We reviewed the correlation between PFTs and stroke severity or degree of disability. Furthermore, we reviewed the PFT change in stroke patients undergoing a respiratory muscle training program. We searched PubMed until September 2023 using inclusion and exclusion criteria in order to identify studies reporting PFTs post-stroke and their change after a respiratory muscle training program. Outcomes included lung function parameters (FEV1, FVC, PEF, MIP and MEP) were measured in acute or chronic stroke survivors. We identified 22 studies of stroke patients, who had undergone PFTs and 24 randomised controlled trials in stroke patients having PFTs after respiratory muscle training. The number of patients included was limited and studies were characterised by great heterogeneity regarding the studied population and the applied intervention. In general, PFTs were significantly reduced compared to healthy controls and predicted normal values and associated with stroke severity. Furthermore, we found that respiratory muscle training was associated with significant improvement in various PFT parameters and functional stroke parameters. PFTs are associated with stroke severity and are improved after respiratory muscle training.
Collapse
Affiliation(s)
- Fotios Drakopanagiotakis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (F.D.); (K.B.); (P.S.)
| | - Konstantinos Bonelis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (F.D.); (K.B.); (P.S.)
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (F.D.); (K.B.); (P.S.)
| | - Dimitrios Tsiptsios
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Anastasia Sousanidou
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Foteini Christidi
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Aimilios Gkantzios
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Styliani Voutidou
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Chrysoula-Maria Takou
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (N.A.)
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (N.A.)
| | - Konstantinos Vadikolias
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| |
Collapse
|
|
25
|
Lee Y, Kim Y, Kim D. Effects of Chest Mobilization and Breathing Exercises on Respiratory Function, Trunk Stability, and Endurance in Chronic Stroke Patients after Coronavirus Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2180. [PMID: 38138283 PMCID: PMC10744534 DOI: 10.3390/medicina59122180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
Background and objectives: This study investigates the effects of chest mobilization and breathing exercises on respiratory function, trunk stability, and endurance in chronic stroke patients who have contracted coronavirus disease (COVID-19). Materials and Methods: Thirty inpatients of a tertiary hospital in South Korea, who had a history of COVID-19 and were diagnosed with stroke within the last 6 months, were randomly assigned to either chest mobilization exercise with breathing exercise (CMEBE) or conservative physical therapy with breathing exercise (CPTBE) groups. The respiratory function, trunk stability, and endurance were measured at baseline and 6 weeks after the interventions. Results: Both CMEBE and CPTBE groups showed improvements in respiratory function, trunk stability, and endurance after the intervention (p < 0.05). However, the CMEBE group showed significantly greater improvements in forced expiratory volume in 1 s (p < 0.05), trunk stability (p < 0.05), and endurance (p < 0.05) than the CPTBE group. No significant intergroup difference was observed in forced vital capacity and peak expiratory flow. Conclusions: The combination of chest mobilization and breathing exercises improved respiratory muscle mobility and endurance, stabilized the trunk, and enhanced balance and the transfer of weight. The findings suggest that this intervention could be beneficial in improving respiratory function and endurance in stroke patients.
Collapse
Affiliation(s)
- Yangjin Lee
- Department of Physical Therapy, Gyeongbuk College, 77 Daehang-ro, Yeongju-si 36133, Republic of Korea;
| | - Yoorim Kim
- Department of Physical Therapy, Gimcheon University, 214 Daehak-ro, Gimcheon 39528, Republic of Korea
| | - Donghoon Kim
- Department of Physical Therapy, Gimcheon University, 214 Daehak-ro, Gimcheon 39528, Republic of Korea
| |
Collapse
|
|
26
|
de Oliveira Vaz L, Galvão AP, Nunes DLM, de Almeida JC, de Fátima Garcia Diniz J, Oliveira-Filho J. Effects of inspiratory muscle training on the severity of obstructive sleep apnea in individuals after stroke: a protocol for a randomized controlled trial. Sleep Breath 2023; 27:2257-2263. [PMID: 37103682 DOI: 10.1007/s11325-023-02825-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing in cerebrovascular diseases, requiring a multidisciplinary approach. There are few studies evaluating the effects of inspiratory muscle training (IMT) in individuals with OSA and the findings regarding the possible effect on apnea hypopnea index (AHI) reduction are controversial. OBJECTIVE This protocol for a randomized clinical trial will assess the effects of IMT on the severity of obstructive sleep apnea, sleep quality, and daytime sleepiness in individuals after stroke participating in a rehabilitation program. METHODS This study will be a randomized controlled trial with blinded assessors. Forty individuals after stroke will randomized to two groups. For 5 weeks, both groups will participate in the rehabilitation program activities, including aerobic exercise, resistance training, and educational class when they will receive guidance on the behavioral management of OSA. The experimental group will also perform high-intensity IMT 5 times a week, for 5 weeks, consisting initially of five sets of five repetitions achieving 75% of the maximal inspiratory pressure, increasing one set each week, totaling nine sets at the end of training. The primary outcome will be the severity of OSA measured as AHI at 5 weeks. Secondary outcomes will include sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness measured by Epworth Sleepiness Scale (ESS). Outcomes will be collected by a researcher blinded to group allocation at baseline (week 0), after intervention (week 5), and 1 month beyond intervention (week 9). TRIAL REGISTRATION Clinical Trials Register: NCT05135494.
Collapse
Affiliation(s)
- Lorena de Oliveira Vaz
- The SARAH Network of Rehabilitation Hospitals, Av Tancredo Neves 2782, Salvador, Bahia, 41820900, Brazil.
- Post-Graduation Program in Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil.
| | - Ana Paula Galvão
- The SARAH Network of Rehabilitation Hospitals, Av Tancredo Neves 2782, Salvador, Bahia, 41820900, Brazil
| | - Daniela Lino Macedo Nunes
- The SARAH Network of Rehabilitation Hospitals, Av Tancredo Neves 2782, Salvador, Bahia, 41820900, Brazil
| | | | | | - Jamary Oliveira-Filho
- Post-Graduation Program in Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil
| |
Collapse
|
|
27
|
Wang Y, Zhang Y, Zhang Y, Wang Z, Guo W, Zhang Y, Wang Y, Ge Q, Wang D. Voluntary Respiration Control: Signature Analysis by EEG. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4624-4634. [PMID: 37955998 DOI: 10.1109/tnsre.2023.3332458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The perception of voluntary respiratory consciousness is quite important in some situations, such as respiratory assistance and respiratory rehabilitation training, and the key signatures about voluntary respiration control may lie in the neural signals from brain manifested as electroencephalography (EEG). The present work aims to explore whether there exists correlation between voluntary respiration and scalp EEG. Evoke voluntary respiration of different intensities, while collecting EEG and respiration signal synchronously. Data from 11 participants were analyzed. Spectrum characteristics at low-frequency band were studied. Computation of EEG-respiration phase lock value (PLV) and EEG sample entropy were conducted as well. When breathing voluntarily, the 0-2 Hz band EEG power is significantly enhanced in frontal and right-parietal area. The distance between main peaks belonging to the two signals in 0-2 Hz spectrum graph tends to get smaller, while EEG-respiration PLV increases in frontal area. Besides, the sample entropy of EEG shows a trend of decreasing during voluntary respiration in both areas. There's a strong correlation between voluntary respiration and scalp EEG. Significance: The discoveries will provide guidelines for developing a voluntary respiratory consciousness identifying method and make it possible to monitor people's intention of respiration by noninvasive BCI.
Collapse
|
|
28
|
de Brito SAF, Scianni AA, Silveira BMF, de Oliveira ERM, Mateus ME, Faria CDCDM. Effects of high-intensity respiratory muscle training on respiratory muscle strength in individuals with Parkinson's disease: Protocol of a randomized clinical trial. PLoS One 2023; 18:e0291051. [PMID: 37682839 PMCID: PMC10490961 DOI: 10.1371/journal.pone.0291051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE To investigate the efficacy of high-intensity respiratory muscle training (combined inspiratory and expiratory muscle training) in improving inspiratory and expiratory muscle strength, inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life in this population. METHODS A randomized controlled trial, concealed allocation, blinded assessments, and intention-to-treat analysis will be carried out. Altogether, 34 individuals with PD (age ≥ 50 years old, with maximum inspiratory pressure (MIP) <80cmH2O or maximum expiratory pressure (MEP) <90cmH2O) will be recruited. Patients will be randomly assigned to either (1) high-intensity respiratory muscle training (experimental group, 60% of MIP and MEP) or (2) sham training (control group, 0cmH2O). Individuals will perform a home-based intervention, with indirect home supervision, consisting of two daily 20-min sessions (morning and afternoon), seven times a week, during eight weeks. Primary outcomes are MIP and MEP. Secondary outcomes are inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life. The effects of the training will be analyzed from the collected data using intention-to-treat. Between-group differences will be measured using a two-way ANOVA with repeated measures (2*3), considering baseline, post-intervention, and 12-week follow-up. IMPACT The results of this trial will provide valuable new information on the efficacy of high-intensity respiratory muscle training in improving muscle strength, functional outcomes, and quality of life in individuals with PD. Performing combined inspiratory and expiratory muscle training using a single equipment is cheaper and feasible, takes less time and is easy to use. In addition, this intervention will be carried out in the home environment that increases accessibility, reduces time, and costs of transport, which increases the feasibility to reproduce their findings in clinical practice. TRIAL REGISTRATION NCT05608941. Registered on November 8, 2022.
Collapse
Affiliation(s)
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Mara Franco Silveira
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Maria Eduarda Mateus
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | |
Collapse
|
|
29
|
Xiang Y, Zhao Q, Luo T, Zeng L. Inspiratory muscle training to reduce risk of pulmonary complications after coronary artery bypass grafting: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1223619. [PMID: 37560113 PMCID: PMC10408668 DOI: 10.3389/fcvm.2023.1223619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023] Open
Abstract
Background Pulmonary complications occur in a substantial proportion of patients who undergo coronary artery bypass grafting. Inspiratory muscle training (IMT), a simple, well-tolerated physical therapy, has been proposed to reduce the risk of complications, but its efficacy remains controversial. Method Randomized controlled trials (RCTs) examining the influence of IMT on the risk of pulmonary complications after coronary artery bypass grafting were identified from PubMed, Embase, CENTRAL, CINAL, and Web of Science through March 2023. Data were meta-analyzed for the primary outcomes of pulmonary complications, defined as pneumonia, pleural effusion, and atelectasis; and in terms of the secondary outcomes of maximum inspiratory pressure, maximum expiratory pressure, length of hospitalization, 6 min walk test, and peak expiratory flow and other outcomes. Risk of bias and quality of evidence assessments were carried out using the RoB 2.0 and Grading of Recommendations Assessment, Development and Evaluation (GRADE) applied to primary outcomes of pulmonary complications. Results Data from eight RCTs involving 755 patients were meta-analyzed. IMT was associated with a significantly lower risk of postoperative pneumonia [relative risk (RR) 0.39, 95% confidence interval (CI) 0.25-0.62, P < 0.0001] and atelectasis (RR 0.43, 95% CI 0.27-0.67, P = 0.0002), but not pleural effusion (RR 1.09, 95% CI 0.62-1.93, P = 0.76). IMT was associated with significantly better maximum inspiratory pressure (preoperative: mean difference (MD) 16.55 cmH2O, 95% CI 13.86-19.24, P < 0.00001; postoperative: mean difference (MD) 8.99 cmH2O, 95% CI 2.39-15.60, P = 0.008) and maximum expiratory pressure (MD 7.15 cmH2O, 95% CI: 1.52-12.79, P = 0.01), and with significantly shorter hospitalization (MD -1.71 days, 95% CI -2.56 to -0.87, P < 0.001). IMT did not significantly affect peak expiratory flow or distance traveled during the 6 min walk test. Conclusions The available evidence from medium and high quality trials suggests that IMT can significantly decrease the risk of pneumonia and atelectasis after coronary artery bypass grafting while shortening hospitalization and improving the strength of respiratory muscles. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42023415817.
Collapse
Affiliation(s)
| | | | | | - Ling Zeng
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| |
Collapse
|
|
30
|
Ramli MI, Hamzaid NA, Engkasan JP, Usman J. Respiratory muscle training: a bibliometric analysis of 60 years' multidisciplinary journey. Biomed Eng Online 2023; 22:50. [PMID: 37217941 DOI: 10.1186/s12938-023-01103-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Over the decades, many publications have established respiratory muscle training (RMT) as an effective way in improving respiratory dysfunction in multiple populations. The aim of the paper is to determine the trend of research and multidisciplinary collaboration in publications related to RMT over the last 6 decades. The authors also sought to chart the advancement of RMT among people with spinal cord injury (SCI) over the last 60 years. METHODS Bibliometric analysis was made, including the publications' profiles, citation analysis and research trends of the relevant literature over the last 60 years. Publications from all time frames were retrieved from Scopus database. A subgroup analysis of publications pertinent to people with SCI was also made. RESULTS Research on RMT has been steadily increasing over the last 6 decades and across geographical locations. While medicine continues to dominate the research on RMT, this topic also continues to attract researchers and publications from other areas such as engineering, computer science and social science over the last 10 years. Research collaboration between authors in different backgrounds was observed since 2006. Source titles from non-medical backgrounds have also published articles pertinent to RMT. Among people with SCI, researchers utilised a wide range of technology from simple spirometers to electromyography in both intervention and outcome measures. With various types of interventions implemented, RMT generally improves pulmonary function and respiratory muscle strength among people with SCI. CONCLUSIONS While research on RMT has been steadily increasing over the last 6 decades, more collaborations are encouraged in the future to produce more impactful and beneficial research on people who suffer from respiratory disorders.
Collapse
Affiliation(s)
- Muhammad Imran Ramli
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
- Biomechatronics and Neuroprosthetics Laboratory, Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
- Biomechatronics and Neuroprosthetics Laboratory, Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Julia Patrick Engkasan
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Juliana Usman
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| |
Collapse
|
|
31
|
Rubio-López AI, Heredia-Ciuró A, Marin-DelaRosa JL, Martín-Núñez J, Granados-Santiago M, De Gracia-Guindo MC, Valenza MC. Role of breathing training programs on quality of life in chronic kidney disease patients. AIMS Public Health 2023; 10:409-421. [PMID: 37304582 PMCID: PMC10251044 DOI: 10.3934/publichealth.2023029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Background Due to its chronic and progressive nature, chronic kidney disease (CKD) affects patients in many spheres including their perception of quality of life (QOL). Breathing training techniques have shown positive effects on health and QOL for different conditions. Objective The aim of this study was to perform a scoping review to examine the characteristics related to the application of breathing training on patients with CKD, and to identify the relevant outcomes and target group for the application of breathing training. Methods This scoping review was performed in accordance with PRISMA-SRc guidelines. We systematically searched three electronic databases for articles published before March 2022. The studies included patients with chronic kidney disease that received breathing training programs. The breathing training programs were compared to usual care or no treatment. Results A total of four studies were included in this scoping review. The four studies had heterogeneous disease stages and breathing training programs. All the studies included reported positive effects of breathing training programs on QOL of CKD patients. Conclusion The breathing training programs were able to improve the quality of life of patients with CKD undergoing hemodialysis treatment.
Collapse
Affiliation(s)
- Ana I. Rubio-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Alejandro Heredia-Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - María Granados-Santiago
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - Marie C. Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| |
Collapse
|
|
32
|
Cui R, Liu H, Li M, Wang J, Mao J, Ni W, Wang F, Pan J, Yu L, Wang Y, Wang Y, Huang P, Li G, Zhao Y, Zhu N, Chen C, Pan Z, Zhang Y, Fu W, Yang J. Effects of "Taking the Waist as the Axis" Therapy on trunk postural control disorder after stroke: A randomized controlled trial. Front Aging Neurosci 2023; 15:1040277. [PMID: 36819714 PMCID: PMC9933551 DOI: 10.3389/fnagi.2023.1040277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Background Sufficient attention to trunk rehabilitation after stroke is still lacking. Loss of trunk selective activity is considered to be the leading cause of trunk postural control disorder after stroke. "Taking the Waist as the Axis" Therapy (WAT) was developed as a combination of the concept of "Taking the Waist as the Axis" from Tai Chi and the rehabilitation of trunk dysfunction after stroke. The present clinical trial examined and assessed the effects of WAT on stroke patients. Methods A total of 43 stroke hemiplegic patients with trunk postural control disorder, whose Trunk Impairment Scale (TIS) scoring between 8 and 18, participated in the present study and were allocated randomly to the experimental (n = 23) or control groups (n = 20). The experimental group received WAT plus conventional therapy, and the control group received "Trunk Selective Activity" Therapy (TSAT) plus conventional therapy. Both groups received treatment once daily and 5 times per week for 3 weeks. The Trunk Impairment Scale (TIS), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), change of Intra-abdominal Pressure (IAP), static balance ability assessment, rapid ventilation lung function test and the Modified Barthel Index (MBI) were evaluated before and after intervention for both groups. Results The experimental group was superior to the control group in TIS [4 (2, 5) vs. 3 (1.25, 4), p = 0.030], change of IAP [-3 (-8, -1.33) vs. -0.02 (-3.08, 6), p = 0.011], FMA-upper extremity [10 (6, 18) vs. 1 (0, 3), p = 0.002], FMA-lower extremity [2 (1, 4) vs. 1 (0, 2), p = 0.009] and FMA [14 (7, 21) vs. 2 (0.25, 3.75), p = 0.001]. Within experimental group, forced vital capacity (FVC) [81.35 (63.30, 94.88) vs. 91.75 (79.40, 97.90), p = 0.02] was significantly improved. Conclusion WAT was an effective trunk treatment after stroke, which significantly improved the patients' trunk posture control ability, motor function and forced vital capacity. However, the results still need to be interpreted with caution for the intervention only lasted for 3 weeks.
Collapse
Affiliation(s)
- Rong Cui
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China,School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Hongtao Liu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Meng Li
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jie Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Junjie Mao
- Department of Respiratory and Critical Care Medicine, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Weidong Ni
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Furong Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jingxian Pan
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Long Yu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yan Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yanmin Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Pufeng Huang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Gaiyan Li
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yi Zhao
- Department of Neurology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Ning Zhu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Chen Chen
- Shanghai Hongrun Boyuan School, Shanghai, China
| | - Ziyang Pan
- Shanghai Yichuan Middle School, Shanghai, China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China,*Correspondence: Ying Zhang, ; Weijie Fu, ; Jianzhong Yang,
| | - Weijie Fu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China,*Correspondence: Ying Zhang, ; Weijie Fu, ; Jianzhong Yang,
| | - Jianzhong Yang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China,*Correspondence: Ying Zhang, ; Weijie Fu, ; Jianzhong Yang,
| |
Collapse
|
|
33
|
Cacciante L, Turolla A, Pregnolato G, Federico S, Baldan F, Rutkowska A, Rutkowski S. The use of respiratory muscle training in patients with pulmonary dysfunction, internal diseases or central nervous system disorders: a systematic review with meta-analysis. Qual Life Res 2023; 32:1-26. [PMID: 35460472 PMCID: PMC9034447 DOI: 10.1007/s11136-022-03133-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this systematic review with meta-analysis was to evaluate the effectiveness of RMT in internal and central nervous system disorders, on pulmonary function, exercise capacity and quality of life. METHODS The inclusion criteria were (1) publications designed as Randomized Controlled Trial (RCT), with (2) participants being adults with pulmonary dysfunction caused by an internal disease or central nervous system disorder, (3) an intervention defined as RMT (either IMT or EMT) and (4) with the assessment of exercise capacity, respiratory function and quality of life. For the methodological quality assessment of risk of bias, likewise statistical analysis and meta-analysis the RevMan version 5.3 software and the Cochrane Risk of Bias Tool were used. Two authors independently analysed the following databases for relevant research articles: PubMed, Scopus, Cochrane Library, Web of Science, and Embase. RESULTS From a total of 2200 records, the systematic review includes 29 RCT with an overall sample size of 1155 patients. Results suggest that patients with internal and central nervous system disorders who underwent RMT had better quality of life and improved significantly their performance in exercise capacity and in respiratory function assessed with FVC and MIP when compared to control conditions (i.e. no intervention, sham training, placebo or conventional treatments). CONCLUSION Respiratory muscle training seems to be more effective than control conditions (i.e. no intervention, sham training, placebo or conventional treatment), in patients with pulmonary dysfunction due to internal and central nervous system disorders, for quality of life, exercise capacity and respiratory function assessed with MIP and FVC, but not with FEV1.
Collapse
Affiliation(s)
- Luisa Cacciante
- Laboratory of Rehabilitation Technologies, Hospital San Camillo IRCCS, Venice, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, Alma Mater University of Bologna, via Massarenti, 9, Bologna, Italy
- Operative Unit of Occupational Medicine, IRCCS Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Giorgia Pregnolato
- Laboratory of Rehabilitation Technologies, Hospital San Camillo IRCCS, Venice, Italy
| | - Sara Federico
- Laboratory of Rehabilitation Technologies, Hospital San Camillo IRCCS, Venice, Italy
| | - Francesca Baldan
- Laboratory of Rehabilitation Technologies, Hospital San Camillo IRCCS, Venice, Italy
| | - Anna Rutkowska
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Sebastian Rutkowski
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| |
Collapse
|
|
34
|
van Kleef ES, Langer D, van Engelen BG, Ottenheijm CA, Voermans NC, Doorduin J. Inspiratory Muscle Training in Nemaline Myopathy. J Neuromuscul Dis 2023; 10:825-834. [PMID: 37458044 PMCID: PMC10578271 DOI: 10.3233/jnd-221665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Respiratory muscle weakness is a common feature in nemaline myopathy. Inspiratory muscle training (IMT) is an intervention that aims to improve inspiratory muscle strength. OBJECTIVE The aim of this controlled before-and-after pilot study was to investigate if IMT improves respiratory muscle strength in patients with nemaline myopathy. METHODS Nine patients (7 females; 2 males, age 36.6±20.5 years) with respiratory muscle weakness and different clinical phenotypes and genotypes were included. Patients performed eight weeks of sham IMT followed by eight weeks of active threshold IMT. The patients trained twice a day five days a week for 15 minutes at home. The intensity was constant during the training after a gradual increase to 30% of maximal inspiratory pressure (MIP). RESULTS Active IMT significantly improved MIP from 43±15.9 to 47±16.6 cmH2O (p = 0.019). The effect size was 1.22. There was no significant effect of sham IMT. Sniff nasal inspiratory pressure, maximal expiratory pressure, spirometry, and diaphragm thickness and thickening showed no significant improvements. CONCLUSIONS This pilot study shows that threshold IMT is feasible in patients with nemaline myopathy and improves inspiratory muscle strength. Our findings provide valuable preliminary data for the design of a larger, more comprehensive trial.
Collapse
Affiliation(s)
- Esmee S.B. van Kleef
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniel Langer
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Cardiovascular and Respiratory Rehabilitation, KU Leuven - University of Leuven, Leuven, Belgium
- Respiratory Rehabilitation and Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Baziel G.M. van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Coen A.C. Ottenheijm
- Department of Physiology, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
|
35
|
Ghannadi S, Noormohammadpour P, Mazaheri R, Sahraian MA, Mansournia MA, Pourgharib Shahi MH, Salmasi Fard AH, Abolhasani M. Effect of eight weeks respiratory muscle training on respiratory capacity, functional capacity and quality of life on subjects with mild to moderate relapsing-remitting multiple sclerosis: A single-blinded randomized controlled trial. Mult Scler Relat Disord 2022; 68:104208. [PMID: 36219925 DOI: 10.1016/j.msard.2022.104208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 09/25/2022] [Accepted: 10/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic inflammatory disease of the nervous system leading to muscle weakness, including the respiratory muscles that cause pulmonary complications, impair functional capacity, increased fatigue, and as a result decreases the quality of life. AIM The purpose of the present study is to examine the influence of 8 weeks of respiratory muscle training (RMT) on pulmonary function and respiratory muscle strength in MS patients. METHODS The present study was a single-blind, randomized controlled trial that was conducted on 36 (27 Female, 9 Male) relapsing-remitting MS patients who were definitively diagnosed by a neurologist and randomly were divided into intervention and control groups. Both groups were educated on lifestyle modification with an emphasis on regular physical activity. In addition, the intervention group was prescribed eight weeks of respiratory muscle training with a threshold resistance device, daily, twice a day for three sets of 15 repetitions per set. Maximal expiratory pressure (PImax), maximal expiratory pressure (PEmax), spirometric indices, functional tests (six-minute walk test, timed up and go test), fatigue questionnaire, and questionnaire of quality of life were assessed before and after trials. RESULTS A total of 36 patients (75% female; mean age 38.00(8.86) years; BMI 26.56(2.64) kg/m2) were included in the study. The strength of inspiratory and expiratory muscles, respiratory function, fatigue, and quality of life were significantly improved in the intervention group (p<0.005). In addition, there was a significant improvement in the rate of fatigue and quality of life in all their dimensions (p<0.005). Only in the six-minute walk test, no significant improvement was seen in the intervention group compared to the control group (p = 0.262). CONCLUSION Findings could help therapists to provide MS patients with more effective respiratory muscle training protocols to maximize the benefits of rehabilitation.
Collapse
Affiliation(s)
- Shima Ghannadi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pardis Noormohammadpour
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mazaheri
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Maryam Abolhasani
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
|
36
|
Lv S, Wang Q, Ni Q, Qi C, Ma Y, Li S, Xu Y. Progress of Muscle Chain Theory in Shoulder Pain Rehabilitation: Potential Ideas for Pulmonary Rehabilitation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2537957. [PMID: 36110187 PMCID: PMC9470317 DOI: 10.1155/2022/2537957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022]
Abstract
Pulmonary dysfunction is very common in stroke patients. A study has shown that acute stroke patients often cause a series of pulmonary dysfunction due to primary damage to the respiratory center, which is an important reason for hindering disease treatment and recovery. American Thoracic Society (ATS) and the European Respiratory Society (ERS) pointed out that pulmonary rehabilitation (PR) can be applied to the rehabilitation of stroke patients to improve their lung function. PR can improve the respiratory muscle strength of stroke patients, which is beneficial to improving the respiratory function of patients. At the same time, it can also significantly increase the maximum oxygen intake of patients, effectively improve the cardiopulmonary function of stroke patients, and reduce respiratory complications such as aspiration pneumonia. However, the common dysfunction of joints and muscles such as shoulder pain after stroke will affect the process of pulmonary rehabilitation. This is mainly because the changes in the position of the shoulder girdle, the decrease in the range of motion of the cervical and thoracic spine, and the changes in the cervical spondylolisthesis position caused by the elevation of the upper limbs will directly affect the breathing movement during the pulmonary rehabilitation process. The instability of the spine will weaken the deep abdominal muscles and reduce the function of the diaphragm; moreover, changes in the alignment and stability of the cervical and thoracic spine will also lead to wrong breathing methods. Therefore, it is of practical clinical significance to evaluate the functional rehabilitation of shoulder joint muscles and evaluate the efficacy of stroke patients to improve their respiratory function. This article through an extensive review of domestic and foreign literature in recent years, combined with clinical practice experience, summarizes the practical application of chain structure theory in the fields of rehabilitation training, postural adjustment, pain relief, etc., and further studies the functional exercise method based on muscle chain theory. The research on the muscle chain of shoulder pain rehabilitation as a model illustrates the positive effect of reconstructing neuroarticular muscle function on the respiratory system, hoping to provide new ideas for the treatment of respiratory diseases in stroke patients.
Collapse
Affiliation(s)
- Shi Lv
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Qian Wang
- Postdoctoral Workstation, Department of Central Laboratory, The Affiliated Taian City Central Hospital of Qingdao University, Taian 271000, China
| | - Qingbin Ni
- Postdoctoral Workstation, Department of Central Laboratory, The Affiliated Taian City Central Hospital of Qingdao University, Taian 271000, China
| | - Chunhua Qi
- Postdoctoral Workstation, Department of Central Laboratory, The Affiliated Taian City Central Hospital of Qingdao University, Taian 271000, China
| | - Yihong Ma
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-0811, Japan
| | - Simin Li
- Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
| | - Yuzhen Xu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| |
Collapse
|
|
37
|
Zhao Z, Sun W, Zhao X, Wang X, Lin Y, Zhang S, Li Z, Lu Y, Gong J, Yu Y, Li B, Hu X, Li Y, Tong Z. Stimulation of both inspiratory and expiratory muscles versus diaphragm-only paradigm for rehabilitation in severe chronic obstructive pulmonary disease patients: a randomized controlled pilot study. Eur J Phys Rehabil Med 2022; 58:487-496. [PMID: 35102732 PMCID: PMC9980572 DOI: 10.23736/s1973-9087.22.07185-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD), a progressive lung disease, might improve with neuromuscular electrical stimulation. No trials on inspiratory plus expiratory neuromuscular electrical stimulation have been conducted yet. AIM The aim of this study was to evaluate the safety and effectiveness of inspiratory plus expiratory neuromuscular electrical stimulation in subjects with severe COPD. DESIGN This was a multicenter, prospective, randomized controlled trial. SETTING The subjects were outpatients enrolled from Beijing Chao-Yang Hospital affiliated with Capital Medical University, Tianjin Chest Hospital, and the First Hospital of Hebei Medical University. POPULATION Subjects had stable COPD with severe respiratory impairment. METHODS Using a computer statistical software, 120 stable subjects were randomly allocated (1:1) to receive inspiratory plus expiratory neuromuscular electrical stimulation (study group) and diaphragm pacing (control group). Demographic and clinical data were collected before, and after 2, and 4 weeks of the trial. The intention-to-treat analysis was conducted. The primary outcome was to analyze the changes in functional exercise capacity, estimated as six-minute walk distance (6MWD), following electrical stimulation for 4 weeks. The secondary outcomes were changes in modified Medical Research Council score, forced expiratory volume in 1 second (FEV<inf>1</inf>), FEV<inf>1</inf>% predicted, and FEV<inf>1</inf> ratio forced vital capacity (FEV<inf>1</inf>/FVC) following electrical stimulation for 4 weeks. RESULTS The change in 6MWD was greater in the study group (65.53±39.45 m) than in the control group (26.66±32.65 m). The mean between-group difference at the fourth week was 29.07 m (95% confidence interval, 16.098-42.035; P<0.001). There were no significant between-group differences in the secondary outcomes after 4 weeks of electrical stimulation. For GOLD-4 COPD subjects, FEV<inf>1</inf> and FEV<inf>1</inf>/FVC improved in the study group (P<0.05). No electrical stimulation-related serious adverse events were observed in either group. CONCLUSIONS 6MWD were increased significantly, without adverse events, after four weeks of treatment of inspiratory plus expiratory neuromuscular electrical stimulation in stable patients with severe COPD, suggesting that this protocol benefits COPD rehabilitation. CLINICAL REHABILITATION IMPACT The results of this study suggest that the simultaneous use of inspiratory plus expiratory neuromuscular electrical stimulation as an adjunct therapy may improve the functional exercise capacity of severe stable COPD subjects.
Collapse
Affiliation(s)
- Zhiling Zhao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wuzhuang Sun
- Department of Respiratory Medicine and PCCM, The First Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | - Xiaoyun Zhao
- Department of Pulmonary and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, China
| | - Xiaojuan Wang
- Department of General Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yingxiang Lin
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shu Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhu Li
- Department of Respiratory Medicine and PCCM, The First Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | - Yong Lu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Juanni Gong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yanxia Yu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Bojun Li
- Department of Pulmonary and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, China
| | - Xiujuan Hu
- Department of Pulmonary and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, China
| | - Yuechuan Li
- Department of Pulmonary and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China -
| |
Collapse
|
|
38
|
The global prevalence of oropharyngeal dysphagia in different populations: a systematic review and meta-analysis. J Transl Med 2022; 20:175. [PMID: 35410274 PMCID: PMC9003990 DOI: 10.1186/s12967-022-03380-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/04/2022] [Indexed: 01/21/2023] Open
Abstract
Background Oropharyngeal dysphagia (OD) refers to any abnormality in the physiology of swallowing in the upper gastrointestinal tract, which leads to the related clinical complications, such as malnutrition, dehydration, and sever complication, such as aspiration pneumonia, suffocation, and eventually, premature death. The previous studies indicated a various range of prevalence of OD. The present systematic review and meta-analysis aimed to standardize the global prevalence of OD in different populations. Methods A systematic literature review was conducted using Embase, Scopus, PubMed, Web of Science (WoS) databases, and Google Scholar motor engine using related MeSH/Emtree and Free Text words, with no time limitation until November 2021. The heterogeneity among studies was quantified using I2 index and the random effects model was used, due to the high heterogeneity among the results of studies included in the meta-analysis. Results The systematic literature search retrieved 2092 studies. After excluding the irrelevant studies, ultimately 27 articles with a sample size of 9841 were included in the meta-analysis. After combining the studies, the overall estimate of the global prevalence rate of OD was 43.8% (95% CI 33.3–54.9%) and the highest prevalence rate was estimated in Africa with 64.2% (95% CI 53.2–73.9%). Given the subgroup analysis based on the study population, the highest prevalence of OD was related to Dementia with 72.4% (95% CI 26.7–95.0%). The results of meta-regression indicated that the prevalence of OD has an increasing trend with the enhancement of year of publication and mean age. Conclusion The results of the present systematic review and meta-analysis revealed that the prevalence of OD is high in different populations and its trend has been increasing in recent years. Therefore, the appropriate strategies should be applied to reduce the prevalence of OD by finding its causation and monitoring at all levels, as well as providing feedback to hospitals.
Collapse
|
|
39
|
Deme S, Lamba D, Alamer A, Melese H, Ayhualem S, Imeru D, Abebe T. Effectiveness of Respiratory Muscle Training on Respiratory Muscle Strength, Pulmonary Function, and Respiratory Complications in Stroke Survivors: A Systematic Review of Randomized Controlled Trials. Degener Neurol Neuromuscul Dis 2022; 12:75-84. [PMID: 35411199 PMCID: PMC8994559 DOI: 10.2147/dnnd.s348736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Stroke is the most common leading cause of mortality and related morbidities worldwide. After stroke, the motor function of extremities and spinal muscles is significantly impairment, but not only this, it also has attributable factors leading to respiratory dysfunction. Nevertheless, to the extent of the authors’ knowledge, there is a dearth of conclusive studies which examined the effectiveness of RMT on muscle strength, pulmonary function, and respiratory complications of individuals after stroke. Objective The purpose of this systematic review was to evaluate the effectiveness of respiratory muscle training on respiratory muscle strength, pulmonary function, and respiratory complications in patients after stroke. Methods An electronic database search of HINARI, PEDro, PubMed, Cochrane Library and Google scholar was used to identify randomized controlled trials that evaluated the effectiveness of respiratory muscle training in patients with stroke. Articles published from 2010 to 2019 were included. The quality of the articles was assessed using PEDro scale. Articles with abstract only, PEDro scores less than 5, published in non-English language, not freely available articles, and quasi experimental studies were excluded from this study. Results The literature search yielded a total of 7 articles (6 randomized controlled trials with 1 pilot randomized controlled trial) which met inclusion criteria despite their heterogeneity. The methodological quality of all studies ranged from 6 to 8 in Pedro score. Most of the articles reported a significant increase in respiratory muscle strength, respiratory muscle function, and reduced risk of complications with a p value <0.05. Conclusion Respiratory muscle training could potentially improve muscle strength and pulmonary functions of subjects after stroke. Thus, it may reduce stroke-related respiratory complications in subjects after stroke. However, further study is warranted with high quality RCTs and pooled synthesis of results.
Collapse
Affiliation(s)
- Sisay Deme
- Department of Physiotherapy, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
- Correspondence: Sisay Deme, Tel +251923272360, Email
| | - Dheeraj Lamba
- Department of Physiotherapy, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abayneh Alamer
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Tibebe Ghion Comprehensive Specialized Hospital, Bahir Dar University, Bahir Dar, Ethiopia
| | - Haimanot Melese
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Tibebe Ghion Comprehensive Specialized Hospital, Bahir Dar University, Bahir Dar, Ethiopia
| | - Sileshi Ayhualem
- Department of Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dechassa Imeru
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegereda Abebe
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
|
40
|
Zhang Y, Wang Z, Ge Q, Wang Z, Zhou X, Han S, Guo W, Zhang Y, Wang D. Soft Exoskeleton Mimics Human Cough for Assisting the Expectoration Capability of SCI Patients. IEEE Trans Neural Syst Rehabil Eng 2022; 30:936-946. [PMID: 35344494 DOI: 10.1109/tnsre.2022.3162578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This paper describes the design of a bionic soft exoskeleton and demonstrates its feasibility for assisting the expectoration function rehabilitation of patients with spinal cord injury (SCI). METHODS A human-robot coupling respiratory mechanic model is established to mimic human cough, and a synergic inspire-expire assistance strategy is proposed to maximize the peak expiratory flow (PEF), the key metric for promoting cough intensity. The negative pressure module of the exoskeleton is a soft "iron lung" using layer-jamming actuation. It assists inspiration by increasing insufflation to mimic diaphragm and intercostal muscle contraction. The positive pressure module exploits soft origami actuators for assistive expiration; it pressures human abdomen and bionically "pushes" the diaphragm upward. RESULTS The maximum increase in PEF ratios for mannequins, healthy participants, and patients with SCI with robotic assistance were 57.67%, 278.10%, and 124.47%, respectively. The soft exoskeleton assisted one tetraplegic SCI patient to cough up phlegm successfully. CONCLUSION The experimental results suggest that the proposed soft exoskeleton is promising for assisting the expectoration ability of SCI patients in everyday life scenarios. SIGNIFICANCE The proposed soft exoskeleton is promising for advancing the application field of rehabilitation exoskeletons from motor functions to respiratory functions.
Collapse
|
|
41
|
Shei RJ, Paris HL, Sogard AS, Mickleborough TD. Time to Move Beyond a "One-Size Fits All" Approach to Inspiratory Muscle Training. Front Physiol 2022; 12:766346. [PMID: 35082689 PMCID: PMC8784843 DOI: 10.3389/fphys.2021.766346] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Inspiratory muscle training (IMT) has been studied as a rehabilitation tool and ergogenic aid in clinical, athletic, and healthy populations. This technique aims to improve respiratory muscle strength and endurance, which has been seen to enhance respiratory pressure generation, respiratory muscle weakness, exercise capacity, and quality of life. However, the effects of IMT have been discrepant between populations, with some studies showing improvements with IMT and others not. This may be due to the use of standardized IMT protocols which are uniformly applied to all study participants without considering individual characteristics and training needs. As such, we suggest that research on IMT veer away from a standardized, one-size-fits-all intervention, and instead utilize specific IMT training protocols. In particular, a more personalized approach to an individual's training prescription based upon goals, needs, and desired outcomes of the patient or athlete. In order for the coach or practitioner to adjust and personalize a given IMT prescription for an individual, factors, such as frequency, duration, and modality will be influenced, thus inevitably affecting overall training load and adaptations for a projected outcome. Therefore, by integrating specific methods based on optimization, periodization, and personalization, further studies may overcome previous discrepancies within IMT research.
Collapse
Affiliation(s)
- Ren-Jay Shei
- Global Medical Department, Mallinckrodt Pharmaceuticals Company, Hampton, NJ, United States
| | - Hunter L Paris
- Department of Sports Medicine, Pepperdine University, Malibu, CA, United States
| | - Abigail S Sogard
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Timothy D Mickleborough
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| |
Collapse
|
|
42
|
Moncion K, Rodrigues L, MacKay-Lyons M, Eng JJ, Billinger SA, Ploughman M, Bailey DM, Trivino M, Bayley M, Thiel A, Roig M, Tang A. Exercise-Based Stroke Rehabilitation: Clinical Considerations Following the COVID-19 Pandemic. Neurorehabil Neural Repair 2022; 36:3-16. [PMID: 34711094 PMCID: PMC8721549 DOI: 10.1177/15459683211054175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background. The COVID-19 pandemic attributable to the severe acute respiratory syndrome virus (SARS-CoV-2) has had a significant and continuing impact across all areas of healthcare including stroke. Individuals post-stroke are at high risk for infection, disease severity, and mortality after COVID-19 infection. Exercise stroke rehabilitation programs remain critical for individuals recovering from stroke to mitigate risk factors and morbidity associated with the potential long-term consequences of COVID-19. There is currently no exercise rehabilitation guidance for people post-stroke with a history of COVID-19 infection. Purpose. To (1) review the multi-system pathophysiology of COVID-19 related to stroke and exercise; (2) discuss the multi-system benefits of exercise for individuals post-stroke with suspected or confirmed COVID-19 infection; and (3) provide clinical considerations related to COVID-19 for exercise during stroke rehabilitation. This article is intended for healthcare professionals involved in the implementation of exercise rehabilitation for individuals post-stroke who have suspected or confirmed COVID-19 infection and non-infected individuals who want to receive safe exercise rehabilitation. Results. Our clinical considerations integrate pre-COVID-19 stroke (n = 2) and COVID-19 exercise guidelines for non-stroke populations (athletic [n = 6], pulmonary [n = 1], cardiac [n = 2]), COVID-19 pathophysiology literature, considerations of stroke rehabilitation practices, and exercise physiology principles. A clinical decision-making tool for COVID-19 screening and eligibility for stroke exercise rehabilitation is provided, along with key subjective and physiological measures to guide exercise prescription. Conclusion. We propose that this framework promotes safe exercise programming within stroke rehabilitation for COVID-19 and future infectious disease outbreaks.
Collapse
Affiliation(s)
- Kevin Moncion
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lynden Rodrigues
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Marilyn MacKay-Lyons
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columba and Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, BC, Canada
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Alzheimer’s Disease Center, Fairway, KS, USA
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michelle Ploughman
- Recovery and Performance Laboratory, BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Damian M. Bailey
- Neurovascular Research Laboratory, University of South Wales Faculty of Life Sciences and Education, Pontypridd, UK
| | - Michael Trivino
- Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
| | - Mark Bayley
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Alexander Thiel
- Jewish General Hospital Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Marc Roig
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
|
43
|
Barnett HM, Davis AP, Khot SP. Stroke and breathing. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:201-222. [PMID: 36031305 DOI: 10.1016/b978-0-323-91532-8.00016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Stroke remains a leading cause of neurologic disability with wide ranging effects, including a variety of respiratory abnormalities. Stroke may influence the central control of the respiratory drive and breathing pattern, airway protection and maintenance, and the respiratory mechanics of inspiration and expiration. In the acute phase of stroke, the central control of breathing is affected by changes in consciousness, cerebral edema, and direct damage to brainstem respiratory centers, resulting in abnormalities in respiratory pattern and loss of airway protection. Common acute complications related to respiratory dysfunction include dysphagia, aspiration, and pneumonia. Respiratory control centers are located in the brainstem, and brainstem stroke causes specific patterns of respiratory dysfunction. Depending on the exact location and extent of stroke, respiratory failure may occur. While major respiratory abnormalities often improve over time, sleep-disordered breathing remains common in the subacute and chronic phases and worsens outcomes. Respiratory mechanics are impaired in hemiplegic or hemiparetic stroke, contributing to worse cardiopulmonary health in stroke survivors. Interventions to address the respiratory complications are under researched, and further investigation in this area is critical to improving outcomes among stroke survivors.
Collapse
Affiliation(s)
- Heather M Barnett
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Arielle P Davis
- Department of Neurology, University of Washington, Seattle, WA, United States
| | - Sandeep P Khot
- Department of Neurology, University of Washington, Seattle, WA, United States.
| |
Collapse
|
|
44
|
Respiratory muscle training improves exercise tolerance and respiratory muscle function/structure post-stroke at short term: A systematic review and meta-analysis. Ann Phys Rehabil Med 2021; 65:101596. [PMID: 34687960 DOI: 10.1016/j.rehab.2021.101596] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/21/2021] [Accepted: 07/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous reviews relating to the effects of respiratory muscle training (RMT) after stroke tend to focus on only one type of training (inspiratory or expiratory muscles) and most based the results on poor-quality studies (PEDro score ≤4). OBJECTIVES With this systematic review and meta-analysis, we aimed to determine the effects of RMT (inspiratory or expiratory muscle training, or mixed) on exercise tolerance, respiratory muscle function and pulmonary function and also the effects depending on the type of training performed at short- and medium-term in post-stroke. METHODS Databases searched were MEDLINE, PEDro, CINAHL, EMBASE and Web of Science up to the end of April 2020. The quality and risk of bias for each included study was examined by the PEDro scale (including only high-quality studies) and Cochrane Risk of Bias tool. RESULTS Nine studies (463 patients) were included. The meta-analysis showed a significant increase in exercise tolerance [4 studies; n = 111; standardized mean difference [SMD] = 0.65 (95% confidence interval 0.27-1.04)]; inspiratory muscle strength [9 studies; n = 344; SMD = 0.65 (0.17-1.13)]; inspiratory muscle endurance [3 studies; n = 81; SMD = 1.19 (0.71-1.66)]; diaphragm thickness [3 studies; n = 79; SMD = 0.9 (0.43-1.37)]; and peak expiratory flow [3 studies; n = 84; SMD = 0.55 (0.03-1.08)] in the short-term. There were no benefits on expiratory muscle strength and pulmonary function variables (forced expiratory volume in 1 s) in the short-term. CONCLUSIONS The meta-analysis provided moderate-quality evidence that RMT improves exercise tolerance, diaphragm thickness and pulmonary function (i.e., peak expiratory flow) and low-quality evidence for the effects on inspiratory muscle strength and endurance in stroke survivors in the short-term. None of these effects are retained in the medium-term. Combined inspiratory and expiratory muscle training seems to promote greater respiratory changes than inspiratory muscle training alone.
Collapse
|
|
45
|
Zhang W, Pan H, Zong Y, Wang J, Xie Q. Respiratory Muscle Training Reduces Respiratory Complications and Improves Swallowing Function After Stroke: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2021; 103:1179-1191. [PMID: 34780729 DOI: 10.1016/j.apmr.2021.10.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/25/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate if respiratory muscle training is capable of reducing the occurrence of respiratory complications and improving dysphagia (swallowing or cough function) after stroke? DESIGN Systematic review of randomized control trials based on the Cochrane guidelines. PARTICIPANTS Patients (> 18 years old) were diagnosed with stroke. INTERVENTION Respiratory muscle training aimed at increasing respiratory muscles' strength by using the threshold resistance trainer or flow-oriented resistance trainer. OUTCOME MEASURES Respiratory complications, swallowing and cough function. RESULTS Eleven trials (n=523 participants) were included . Respiratory muscle training reduced the risk of respiratory complications (RR0.51, 95%CI 0.28 to 0.93, I2 = 0%,P=0.03, ARD =0.068, NNT=14.71) compared with no/sham respiratory intervention. It also decreased the liquid type PAS scores by 0.81 (95% CI -1.19 to -0.43, I2 = 39%, P<0.0001). There was no significant association between respiratory muscle training and FOIS scores, cough function:increased FOIS scores by 0.47 (95%CI -0.45 to 1.39, I2 = 55%, P=0.32), decreased PECF-VC by 18.70 L/min (95%CI -59.74 to 22.33, I2 = 19%, P=0.37) and increased PECF-RC by 0.05 L/min (95% CI -40.78 to 40.87 I2 = 0%, P=1.00) . CONCLUSION This meta-analysis provided evidence that respiratory muscle training is effective in reducing the risk of respiratory complications, and improving dysphagia by reducing penetration or aspiration during swallowing liquid bolus after stroke. However, there was no sufficient evidence to determine that respiratory muscle training improves cough function. Additional multi-center studies using larger patient cohorts are required to validate and support these findings. Furthermore, long-term follow-up studies should be performed to measure outcomes, at the same time avoiding bias due to confounding factors such as heterogeneity of the etiologies of dysphagia.
Collapse
Affiliation(s)
- Weisong Zhang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Huijuan Pan
- Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
| | - Ya Zong
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Jixian Wang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.
| |
Collapse
|
|
46
|
Morrison RA, Hays SA, Kilgard MP. Vagus Nerve Stimulation as a Potential Adjuvant to Rehabilitation for Post-stroke Motor Speech Disorders. Front Neurosci 2021; 15:715928. [PMID: 34489632 PMCID: PMC8417469 DOI: 10.3389/fnins.2021.715928] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/28/2021] [Indexed: 01/22/2023] Open
Abstract
Stroke often leaves lasting impairments affecting orofacial function. While speech therapy is able to enhance function after stroke, many patients see only modest improvements after treatment. This partial restoration of function after rehabilitation suggests that there is a need for further intervention. Rehabilitative strategies that augment the effects of traditional speech therapy hold promise to yield greater efficacy and reduce disability associated with motor speech disorders. Recent studies demonstrate that brief bursts of vagus nerve stimulation (VNS) can facilitate the benefits of rehabilitative interventions. VNS paired with upper limb rehabilitation enhances recovery of upper limb function in patients with chronic stroke. Animal studies reveal that these improvements are driven by VNS-dependent synaptic plasticity in motor networks. Moreover, preclinical evidence demonstrates that a similar strategy of pairing VNS can promote synaptic reorganization in orofacial networks. Building on these findings, we postulate that VNS-directed orofacial plasticity could target post-stroke motor speech disorders. Here, we outline the rationale for pairing VNS with traditional speech therapy to enhance recovery in the context of stroke of speech motor function. We also explore similar treatments that aim to enhance synaptic plasticity during speech therapy, and how VNS differs from these existing therapeutic strategies. Based on this evidence, we posit that VNS-paired speech therapy shows promise as a means of enhancing recovery after post-stroke motor speech disorders. Continued development is necessary to comprehensively establish and optimize this approach, which has the potential to increase quality of life for the many individuals suffering with these common impairments.
Collapse
Affiliation(s)
- Robert A Morrison
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, United States
| | - Seth A Hays
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, United States.,Erik Jonsson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, TX, United States
| | - Michael P Kilgard
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, United States
| |
Collapse
|
|
47
|
An HJ, Kim AY, Park SJ. Immediate Effects of Diaphragmatic Breathing with Cervical Spine Mobilization on the Pulmonary Function and Craniovertebral Angle in Patients with Chronic Stroke. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:826. [PMID: 34441033 PMCID: PMC8398052 DOI: 10.3390/medicina57080826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Patients with stroke have a forward neck posture due to neurological damage and often have impaired pulmonary function. This study investigated the effect of diaphragmatic breathing with cervical mobilization to improve pulmonary function cervical alignments. Materials and Methods: This study used a one-group pre-test-post-test design including 20 patients with stroke. Two types of cervical joint mobilization techniques, consisting of left and right lateral glide mobilization and posterior-anterior mobilization, were utilized. During joint mobilization, the patients performed diaphragmatic breathing. The measurements were performed immediately after the intervention. Pulmonary function was evaluated using a spirometer to measure the forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). The craniovertebral angle (CVA) was measured using lateral photographs. Results: After diaphragm breathing with cervical joint mobilization, subjects had significantly increased FEV1, FVC, PEF and CVA. Conclusion: Diaphragm breathing with cervical joint mobilization are possible interventions to increase pulmonary function and improve the craniovertebral angle in patients with stroke. However, a complete conclusion can be reached only after a follow-up study has been conducted with a comparison of more subjects and controls.
Collapse
Affiliation(s)
- Ho Jung An
- Department of Physical Therapy, Dongnam Health University, 50, Cheoncheon-ro 74beon-gil, Jangan-gu, Suwon-si 16328, Gyeonggi-do, Korea;
| | - A Yeon Kim
- Department of Physical Therapy, Graduate School, Yongin University, 134, Yongindaehak-ro, Cheoin-gu, Yongin-si 17092, Gyeonggi-do, Korea;
| | - Shin Jun Park
- Department of Physical Therapy, Suwon Women’s University, 1098, Juseok-ro, Bongdam-eup, Hwaseong-si 18333, Gyeonggi-do, Korea
| |
Collapse
|
|
48
|
He Y, Zhao C, Liu Y. Effects of respiratory muscle training on cough function in neurological disorders: A systematic review with meta-analysis. NeuroRehabilitation 2021; 48:441-449. [PMID: 33967068 DOI: 10.3233/nre-210017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with neurological disorders can present the weakness of respiratory muscle and impaired cough function. Previous studies have shown that respiratory muscle strength training (RMT) is an effective method of improving the strength of respiratory muscle. The effects of RMT on cough function remain controversial. OBJECTIVE We aimed to analyze randomized controlled trials (RCTs) that investigated the effects of RMT on cough function of patients with neurological disorders. METHODS Pubmed, Medline, Embase, and the Cochrane Library were searched electronically for RCTs. Two reviewers independently performed data extraction and quality assessment. Data were analyzed by using RevMan 5.3 software of The Cochrane Collaboration. RESULTS Five studies with 185 participants were included. The mean PEDro score was 6.2 (range 5 to 7), showing moderate methodological quality. Random-effects meta-analyses showed that respiratory muscle training improved peak expiratory cough flow of voluntary cough by 2.16 (95% CI 1.16 to 3.17) and involuntary cough by 2.84 (95% CI 1.29 to 4.39), with statistical significance (P < 0.0001, P = 0.0003). The experimental group had an improvement of 0.19 cmH2O (95% CI -0.12 to 0.5) on the maximal inspiratory pressure, 0.09 cmH2O (95% CI -0.23 to 0.42) on the maximal expiratory pressure, but with no statistical significance (P = 0.23, P = 0.58) between groups. CONCLUSION Respiratory muscle training was considered as an effective method for improving cough function. However, this review was insufficient to conclude whether respiratory muscle training was effective in improving inspiratory and expiratory muscle strength, this was opposite with previous meta-analysis. These effects might due to the small samples and different diseases.
Collapse
Affiliation(s)
- Yi He
- Department of Pain and Rehabilitation, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chen Zhao
- Department of Orthopedic, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Liu
- Department of Pain and Rehabilitation, Xinqiao Hospital, Army Medical University, Chongqing, China
| |
Collapse
|
|
49
|
Abstract
The application of exercise science training knowledge has been of growing interest to voice professionals. This tutorial, derived from the authors' invited presentations from the "Exercise and the Voice" Special Session at the 2018 Voice Foundation Symposium, proposes a foundational theoretical structure based in exercise science, clarifies the wide range of variables that may influence voice training, and summarizes our present understanding of voice physiology from the perspective of muscle training. The body of literature on voice exercise was then analyzed from the perspective of this framework, identifying what we currently know and what we still have yet to learn.
Collapse
Affiliation(s)
- Aaron M Johnson
- Department of Otolaryngology - Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York.
| | - Mary J Sandage
- Department of Communication Disorders, Auburn University, Auburn, Alabama
| |
Collapse
|
|
50
|
Guillen-Sola A, Messaggi-Sartor M, Ramírez-Fuentes C, Marco E, Duarte E. The Retornus-2 study: impact of respiratory muscle training in subacute stroke patients with dysphagia, study protocol of a double-blind randomized controlled trial. Trials 2021; 22:416. [PMID: 34172071 PMCID: PMC8229262 DOI: 10.1186/s13063-021-05353-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background Stroke can lead to varying degrees of oropharyngeal dysphagia, respiratory muscle dysfunction and even increase medical complications such as aspiration, malnutrition and death. Recent studies suggest that inspiratory and expiratory respiratory muscle training (IEMT) can improve swallowing efficacy and may reduce aspiration events. The main purpose of this study is to examine whether an 8-week IEMT programme can improve respiratory muscle strength and swallow dysfunction severity in subacute stroke patients with dysphagia. Methods Retornus-2 is a two-arm, prospectively registered, randomized controlled study with blinded assessors and the participation of fifty individuals who have suffered a stroke. The intervention group undergoes IEMT training consisting of 5 sets of 10 repetitions, three times a day for 8 weeks. Training loads increase weekly. The control group undergoes a sham-IEMT protocol. The primary outcome examines the efficacy of the IEMT protocol to increase respiratory muscle strength and reduce dysphagia severity. The secondary outcome assesses the longitudinal impact of dysphagia on body composition and nutritional assessment over a 6-month follow-up. Discussion IEMT induces an improvement in respiratory muscle strength and might be associated with relevant benefits in dysphagia patterns, as well as a reduction in the number of aspiration events confirmed by videofluoroscopy or fiberoptic endoscopic evaluation of swallowing. The description of the impact of swallowing impairment on nutritional status will help develop new strategies to face this known side-effect. Trial registration Clinicaltrials.gov NCT03021252. Registered on 10 January 2017. https://clinicaltrials.gov/ct2/results?cond=retornus+2&term=&cntry=ES&state=&city=&dist= WHO trial Registration data set: Due to heavy traffic generated by the COVID-19 outbreak, the ICTRP Search Portal does not respond. The portal recommends other registries such as clinicaltrials.gov. Protocol version: RETORNUS 2_ PROTOCOL_2. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05353-y.
Collapse
Affiliation(s)
- A Guillen-Sola
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Barcelona, Spain. .,Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain.
| | - M Messaggi-Sartor
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Barcelona, Spain.,Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - C Ramírez-Fuentes
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Barcelona, Spain.,Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - E Marco
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Barcelona, Spain.,Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - E Duarte
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Barcelona, Spain.,Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| |
Collapse
|